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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
274417618
Report Date:
06/08/2023
Date Signed:
06/08/2023 02:55:55 PM
Document Has Been Signed on
06/08/2023 02:55 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
RUIZ RAMIREZ, LAURA
FACILITY NUMBER:
274417618
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
1
DATE:
06/08/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:00 PM
MET WITH:
Laura Ruiz Ramirez
TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced case management inspection to the home today. LPA met with licensee Laura Ruiz Ramirez. LPA observed that licensee's 3 years old was present. Licensee had contacted LPA and wanted LPA to review on her files and see if she is missing something. Licensee is doing all paper work required. LPA obtained a copy of the roster today and observed that licensee is working with the program MAOF who has referred six children to her FCCH.
No deficiencies were cited today.
A notice of Site inspection was printed and licensee was instructed to post it for 30 consecutive days.
SUPERVISORS NAME
:
Mary Segura
LICENSING EVALUATOR NAME
:
Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/08/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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