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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216183
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:19:26 PM

Document Has Been Signed on 09/20/2022 03:19 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 CAREFACILITY NUMBER:
426216183
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 4DATE:
09/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jessica RamirezTIME COMPLETED:
03:45 PM
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On September 20, 2022 @ 2:00 PM, LPA asked Juana Garcia, Pre- Screening questions related to COVID-19. Assistant's responses to the Pre-screening questions suggest no COVID-19 exposure on site.

On 9/20/2022, Licensing Program Analyst (LPA) Martina Jimenez, conducted an unannounced Case Management inspection to follow up on the report of an Unusual Incident Report (UIR) received by the Department on 9/7/2022. A child #1 (C1) was being chased by C2, C1 fell, hitting the right eyelid on the cubbies, the eyelid became swollen with a bump and a small cut. When mother arrived, the mother determined that C1 did not required medical attention.

LPA met with Jessica Ramirez, licensee, Juana Garcia, Assistant and Ezequiel Ramirez, husband. LPA explained the purpose of the inspection. LPA and licensee viewed the cubbies located in the living room. Licensee stated will be putting edge cushion on the cubbies to prevent future incidents. LPA requested a photo of the cubbies be email to LPA with the edge cushion attached to the cubbies by 9/21/2022.

The licensee stated C1 returned to care on 9/8/2022, with no restrictions. Licensee stated C1 has not prolonged issues related to the injuries.

Based on observations and the interview with licensee, and staff, it is determined neither the equipment at the FCC nor the actions of the FCC's staff contributed to C1's incident. LPA best categorized the incident as an accident.

There were no deficiencies cites at this time. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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