426216183-10-14-2021-17-CC-FVEZ-C7SRPC-20211014131144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216183
Report Date: 10/14/2021
Date Signed: 10/14/2021 01:11:54 PM

Document Has Been Signed on 10/14/2021 01:11 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	RAMIREZ DIAZ FAMILY CHILD CARE		FACILITY NUMBER:	426216183
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/14/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Jessica Ramirez Diaz		TIME COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/14/2021, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced pre-licensing inspection of the facility. Prior to entering the facility, LPA conducted a COVID-19 pre-screening questionnaire and based on Applicant’s responses it was determined that the home is safe and free of any COVID-19 exposures. LPA met with Applicant, Jessica Ramirez Diaz and explain the purpose of the Inspection. During this inspection, there were no children present at the facility. LPA conducted the physical plant tour of the home. During this tour the following was noted: Applicant applied for a Small Family Child Care license on 08/30/2021. Family members residing in the home are adults (7) adults. All adults in the home are fingerprint cleared. Per Applicant, the operating days and hours of the day care will be Monday through Friday from 5:00 AM – 5:30 PM and Saturday 5:00 AM – 2:00 PM. Applicant states she wants to care for children from birth to twelve (12) years of age. All areas identified on the facility sketch were inspected. This is a one (1) story home which consists of four (4) bedrooms, three (3) bathrooms, living room, dining area, kitchen, laundry room that leads to the garage, shed/patio, and backyard. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed the designated day care areas to be safe with age appropriate toys, games etc. The back yard is enclosed with wooden fence. There are no bodies of water observed. Off limit areas include: (4) bedrooms, two (2) bathrooms, laundry room that lead to garage, shed/patio area, and backyard. LPA observed safety door knobs on all bedroom doors and laundry room making these areas inaccessible to children in care. LPA also observed a door safety knob in the garage door for extra security measure. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RAMIREZ DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 426216183
	VISIT DATE: 10/14/2021

NARRATIVE

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Areas used by children included: living room, dining area, kitchen one, and (1) bathroom located in the hallway of the facility. LPA observed age appropriate toys and napping equipment in the main day care area. LPA observed a fire place in the living room that is made inaccessible by a book shelve. Knives are stored out children’s reach in a high cabinet in the kitchen that is inaccessible to children. The required fire extinguisher 2A10BC was purchased in 04/15/2021. LPA reminded Applicant that fire extinguisher needs to be purchased or serviced annually. LPA observed a combination smoke and carbon monoxide detector in the kitchen of the facility that was tested 10:43 AM and was functioning at the time of the visit. Per Applicant, there are no guns nor ammunition in the home. First Aid and emergency kits are available. Applicant stated that medication used by Applicant’s family are stored in their bedrooms, all of which are inaccessible to children in care. The Applicant completed the Orientation on 08/24/2021. The Applicant has current Pediatric First Aid and CPR which expires 10/17//2022. Applicant completed Preventative Health Training including lead component on 10/14/2020. Applicant completed the Mandated Reporter Training on 01/26/2021. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles.

The following was discussed with the applicant:
· Individuals who are 18 years of age or older living in the home or working in the home, must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain the Criminal Record Background Check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization's, and a valid criminal record clearance associated to the facility license.
· A current roster of children enrolled must be available for review and maintained for a period of three years, even after children are no longer attending the facility.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
· Changes in the home should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if applicant moved to another location/ home.

CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RAMIREZ DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 426216183
	VISIT DATE: 10/14/2021

NARRATIVE

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Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a Family Child Care Home, 24/7.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

Incidental Medical Services (IMS) policy was discussed. Applicant stated facility will not administer medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Department inspection rights authority.

LPA, and Applicant reviewed Safe Sleep Regulations. LPA provided a copy of PIN 20-24 and LIC 9227 and reviewed regulations with Applicant.

LPA also advised against sleeping infants in a separate room.

During this visit, LPA assisted Applicant iin registering their emails to receive Provider Information Notices (PINs). LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) with the Applicant and Assistant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RAMIREZ DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 426216183
	VISIT DATE: 10/14/2021

NARRATIVE

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Forms to be posted
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse.
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).

Children’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children in Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA reviewed and provided copy of Guidance for Child Care Providers and Programs updated on 06/29/2021.

Exit interview was conducted with Applicant, Jessica Ramirez Diaz. Notice of site visit was printed and posted by Applicant prior to LPA leaving the facility. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

Pre-licensing inspection and review of this report was conducted in English and Spanish as Applicant speaks both languages and requested documentation be provided in both English and Spanish.

The home meets Title 22 Division 12 California Code of Regulations requirements of a Small Family Child Care Home (FCCH). Effective date of license is 10/14/2021.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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