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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411131
Report Date: 12/18/2023
Date Signed: 12/18/2023 04:02:08 PM

Document Has Been Signed on 12/18/2023 04:02 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VELAZQUEZ-RAMIREZ, MAURAFACILITY NUMBER:
434411131
ADMINISTRATOR:RAMIREZ, MAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 292-8517
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
12/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Maura Velazquez-RamirezTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensee Program Analyst (LPA) Deanna Villagrana met with licensee Maura Velazquez-Ramirez for a case management visit. LPA explained the nature of the visit. Present were licensee, licensee's husband, licensee's assistant Irma Hinojoza Minero and nine day care children including two infants. Two additional children and assistant Maribel Rojas arrived during visit. Three of the children are licensee's grandchildren and one infant is assistant's grandchild.

LPA observed Maribel Rojas does not have fingerprint clearance. Licensee states she has not had her fingerprinted. Maribel states she has been working at the facility for about three months. LPA observed a baby walker and baby bouncer in the home with no children in them. Licensee states she children use them to play. LPA observed an infant asleep swaddled in a blanket with a play mat that has two arches and a toy attached inside the playpen. Infant had a pacifier with a stuffed animal attached to it in its mouth. LPA requested to see Safe Sleep log for infants in care. Licensee showed LPA a log that was last update in August for one child and June for another child. LPA did not observe a current roster of children.

The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA Deanna Villagrana informed licensee Maura Velazquez-Ramirez that this report dated 12/18/2023 document(s) 4 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Maura Velazquez-Ramirez to provide a copy of this licensing report dated 12/18/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VELAZQUEZ-RAMIREZ, MAURA
FACILITY NUMBER: 434411131
VISIT DATE: 12/18/2023
NARRATIVE
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or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
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Document Has Been Signed on 12/18/2023 04:02 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 12/18/2023 at 01:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VELAZQUEZ-RAMIREZ, MAURA
FACILITY NUMBER: 434411131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/18/2023
Section Cited
CCR
102370(d)(2)

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Prior to working, or volunteering in a licensed home, all licensees and personnel as specified shall request a transfer of a criminal record clearance as specified in Section 102370(j)
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LPA provided Live Scan form to licensee and informed Maribel Rojas she needed to be cleared before returning to the home. Maribel Rojas left during visit.
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This requirement was not met as evidenced by LPA observed Maribel Rojas does not have fingerprint clearance. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Type A
12/19/2023
Section Cited
CCR102425(b)

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Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by LPA observed a play mat that has two arches and a toy attached inside the playpen
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Licensee will submit a statement stating she understands she may not use such items when infants are asleep in play yard.
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This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


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Document Has Been Signed on 12/18/2023 04:02 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 12/18/2023 at 01:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VELAZQUEZ-RAMIREZ, MAURA
FACILITY NUMBER: 434411131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2023
Section Cited
CCR
102425(f)

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An infant shall not be swaddled while in care. This requirement was not met as evidenced by LPA observed an infant asleep swaddled in a blanket. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Licensee's assistant removed blanket. Licensee will submit a statement stating her and her assistants have read the Safe Sleep regulations to CCLD by POC date.
Type A
12/19/2023
Section Cited
CCR
101425(b)(1)(A)

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There shall not be anything attached to the pacifier. This requirement was not met as evidenced by Infant had a pacifier with a stuffed animal attached to it in its mouth.
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Licensee's assistant removed pacifier. Licensee will submit a statement stating her and her assistants have read the Safe Sleep regulations to CCLD by POC date.
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This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


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Document Has Been Signed on 12/18/2023 04:02 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 12/18/2023 at 01:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VELAZQUEZ-RAMIREZ, MAURA
FACILITY NUMBER: 434411131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2023
Section Cited
CCR
102417(g)(10)

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A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c). This requirement was not met as evidenced by LPA observed a baby walker and baby bouncer in the home with no children in them.
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Items belong to licensee's daughter who states she will be discardingof them.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
12/26/2023
Section Cited
CCR102425(j)(2)

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The provider shall check and document the following: This requirement was not met as evidenced by LPA requested to see Safe Sleep log for infants in care. Licensee showed LPA a log that was last update in August for one child and June for another child.
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Licensee will submit a Safe Sleep log for infants in care for week of 12/19/2023 through 12/22/2023 to CCLD by POC date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


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Document Has Been Signed on 12/18/2023 04:02 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 12/18/2023 at 01:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VELAZQUEZ-RAMIREZ, MAURA
FACILITY NUMBER: 434411131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2023
Section Cited
CCR
102417(g)(8)

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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met as evidenced by LPA did not observe a current roster of children.
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Licensee completed roster during visit.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


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