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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624865
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:36:04 AM

Document Has Been Signed on 05/19/2023 10:36 AM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:RAMIREZ, CAROLINAFACILITY NUMBER:
343624865
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Carolina RamirezTIME COMPLETED:
10:45 AM
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On 5/19/2023, Licensing Program Analyst (LPA) Amanda Sutter met with Licensee Carolina Ramirez for the purpose of an unannounced case management inspection. Upon arrival, licensee's cousin and two minor children were also present.

A health and safety evaluation was conducted in all areas accessible to children. LPA observed that the facility is clean, safe, sanitary, and in good repair. Licensee requested to place hallway and bedroom 1 on limits. Licensee provided LPA with updated facility sketch. During today's visit, LPA has approved the hallway and bedroom 1 as on-limits. Off-limit areas include: left-hand side yard, storage room, and bedrooms 2, 3, and 4. Licensee acknowledges that children may never enter these off-limit areas.

A notice of site visit was provided and must remain posted for 30 days. Based on the inspection, no citations have been issued. Exit interview conducted and report was reviewed with the licensee Carolina Ramirez.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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