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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 274415989
Report Date: 10/03/2022
Date Signed: 10/03/2022 10:20:27 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2022 and conducted by Evaluator Susy Cervantes
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220701133722
FACILITY NAME:RAMIREZ PEREZ, CARLOSFACILITY NUMBER:
274415989
ADMINISTRATOR:CARLOS RAMIREZ PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 214-4846
CITY:SALINASSTATE: ZIP CODE:
93907
CAPACITY:14CENSUS: 4DATE:
10/03/2022
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Eliza VasquezTIME COMPLETED:
10:25 AM
ALLEGATION(S):
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Unauthorized movement/transportation of children in care.
INVESTIGATION FINDINGS:
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On 10/03/2022 at 09:40 AM, Licensing Program Analyst (LPA) Susy Cervantes, met with assistant, Eliza Vasquez, to deliver complaint findings. Present was licensee with 4 children: two infants and two preschool. Shortly after arrival, licensee, Carlos Ramirez Perez, arrived

Based on LPAs interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Type A deficiency was cited during today's visit. Due to the issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 dated 10/03/22, must be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Copies of the fact sheet Parent Notification Requirement and of LIC 9224 were provided to licensee. A signed copy of LIC 9224 will be placed in each child's file.

LPA discussed the requirements of AB633 to Licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Licensee understands the requirements. Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with assistant, Carlos Ramirez Perez.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20220701133722
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: RAMIREZ PEREZ, CARLOS
FACILITY NUMBER: 274415989
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2022
Section Cited
CCR
102423
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102423 Personal Rights
Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative.
This requirement was not met as evidenced by:
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Licensee will schedule a non-compliance meeting at the San Jose Reginal Office by close of business 10/04/2022
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Based on interviews: The licensee was transporting children to another licensed facility which is an immediate risk to the health, safety, and personal rights of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2