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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416045
Report Date: 06/06/2023
Date Signed: 06/06/2023 01:13:24 PM

Document Has Been Signed on 06/06/2023 01:13 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:RUIZ TORRES, EVELYNFACILITY NUMBER:
434416045
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Evelyn Ruiz TorresTIME COMPLETED:
01:15 PM
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On 06/06/2023 at 10:55 AM, Licensing Program Analyst (LPA) Teodoro Trujillo conducted an unannounced annual and change of capacity visit to the home with fire inspection approval date of 04/10/2023. LPA met with licensee Evelyn Ruiz Torres, and explained the nature of today's visit to her. The adults that reside in the home are the Applicant, her spouse and brother in law. Days and hours of operation will be Monday - Friday from 7:300 AM to 5:30 PM.
A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 5/15/2023 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA inspected inside and outside of single-story home. LPA observed a barricaded fireplace, no wall heater, no stairs, and no bodies of water. Licensee stated there are no weapons. Licensee states she has a vaccinated cat. LPA observed a 2A10BC fire extinguisher last purchased on 02/28/2023. Carbon Monoxide and smoke detectors are operable. Sharp objects, medicines, poisons, and cleaning supplies were inaccessible to children in care. Off limit areas inside the home: kitchen, bedroom 1 with bathroom, bedroom 2 and attached garage. On limit areas: Day care area, nap room and dining room. Backyard is fenced. Off limits outdoor: gated right side of back yard that is fenced off. On limit areas outside the home: left yard play area

Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to her license. Licensee stated she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.


Continues report dated 06/06/2023 pg. 1/2
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: RUIZ TORRES, EVELYN
FACILITY NUMBER: 434416045
VISIT DATE: 06/06/2023
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Continuation of report dated 06/06/2023 pg. 2/2
LPA observed a current roster of the children. LPA observed a fire and disaster drill log last performed on 03/07/2023. LPA reviewed 5 children’s files and observed all required documentation was in compliance. Infant individual sleeping plan (LIC 9227) for each infant under 12 months was discussed and a 15-minute check sleep log for infants under 24 months was provided. LPA observed licensee completed Mandated Reporter Training on 05/22/2023, assistant Ingris completed on 04/04/2023 and assistant Herlinda last completed on 10/19/2022. Licensee has Pediatric CPR/1st Aid expiring on 05/04/2025, assistant Ingris expires on 01/28/2025, assistant Herlinda expires on 04/30/2024. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is current for licensee, and all adults residing in the home.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS currently. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed in Spanish with the licensee, Evelyn Ruiz Torres. 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. LPA advised applicant that license for a large family child care home is granted pending Licensing Program Manager approval.

Continues report dated 06/06/2023 pg. 2/2

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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