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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004682
Report Date: 09/18/2023
Date Signed: 09/18/2023 04:32:54 PM

Document Has Been Signed on 09/18/2023 04:32 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:RAMIREZ ORTIZ, ANGELICA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(407) 285-4142
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/18/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Angelica RamiezTIME COMPLETED:
04:40 PM
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On 9/18/2023 at 4:00PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Angelica Ramirez Ortiz. Purpose of inspection was explained and was for an Unannounced, Case Management inspection to add bedrooms #4, #5 to the on-limit area. Present was the licensee, helper caring for four children (3 infants, 1 preschool age). Adults have criminal record clearances on file. Licensee’s home is a 6- bedroom, 3- bathroom, 2- level house. 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 4:05PM., LPA observed the following: Bedroom #4 was clean, equipped with infant play pen with tight-fitting sheet. Per licensee, bedroom #4 will be used for napping infants only.

On 9/18/2023, Bedroom #4, was added to on-limit areas.

**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: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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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