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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004682
Report Date: 08/14/2023
Date Signed: 08/14/2023 04:08:00 PM

Document Has Been Signed on 08/14/2023 04:08 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:RAMIREZ ORTIZ, ANGELICA M.FACILITY NUMBER:
384004682
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/14/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Angelica Ramirez OrtizTIME COMPLETED:
04:20 PM
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On 8/14/2022 at 3:10PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Angelica Ramirez Ortiz. Purpose of inspection was explained and was for an unannounced, Follow-up: Case Management inspection for increase in capacity. Present was the licensee, helper caring for three children (2 infants, 1 preschool age). All adults have criminal record clearances on file. Licensee’s home is a 6- bedroom, 3- bathroom, 2- level house. Days and hours of operations are: Monday- Friday, 8:00AM.- 5:00PM. Day-care Areas are: Main Building: 2nd Level: Living Room (Playroom #1), Dining Room (Playroom #2), Bathroom #1; and Ground Level: Outside Play Area (Patio). Off-limit Areas are: Ground Level: Converted Garage: Bedrooms #1, #2, Bathroom #2; Main Building: Ground Level: Bedroom #3/ Office, Laundry Room, Bathroom #3, Main Building 2nd level: Bedrooms: #4, #5, #6, Kitchen (Pass through only), and Hallway (Pass through only). LPA inspected home with licensee for health and safety hazards.

At 3:10PM, LPA observed the following: Playroom #1, #2, is set up for childcare services. Licensee has child sized tables and chairs for snack and activities. Age-appropriate playthings are available for children in care.

Floor and ground surfaces, in hallway, have been cleared of obstruction or potential hazards. LPA observed safety locks installed on playroom windows for added safety.



Earthquake Preparedness Checklist (LIC9149) has been posted in entry way.
Licensee’s Fire Safety Clearance has been granted.

LPA reminder licensee to remove bouncer chair from facility. Bouncer chair was removed during inspection.

On 8/14/2023, Licensee was recommended for Increase in Capacity/ Room Addition.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapter. 3**



Report was reviewed and copy was issued to Licensee, Angelica Ramirez Ortiz. This report will be kept in the facility file and made available for public review upon request.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2023
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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