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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417746
Report Date: 06/09/2025
Date Signed: 06/09/2025 03:34:36 PM

Document Has Been Signed on 06/09/2025 03:34 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:RAMIREZ VASQUEZ, ANNETTFACILITY NUMBER:
434417746
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/09/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:07 PM
MET WITH:Annett Ramirez VasquezTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Manager (LPM), Susy Cervantes, Licensing Program Analyst (LPA), Pedro Solorio-Gutierrez met at the San Jose Regional Office today for a scheduled informal meeting with Licensee, Annett Ramirez Vasquez. Annett's aunty Eduviguz Ramirez was present during the meeting The purpose of the informal conference was to discuss previous citations, of personal rights of children in care regarding a complaints received on 08/22/2024 and 03/14/2025, and to discuss previous citations during annual inspections. LPM reviewed the deficiencies with Licensee and discussed how the Family Child Care Home (FCCH) will maintain compliance with the deficiencies cited below.

The Department of Social Services, Community Care Licensing Division has determined that Licensee, Annett Ramirez Vasquez has violated the following licensing regulations pertaining to the operation of her Family Child Care Home:

The following issues/violations were discussed:

· 102423(a)(2) – Personal Rights – To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

· 1596.8595(d)(3) Administration of Child Day Care Licensing – The licensee shall require each recipient of the licensing document pertaining to a conference to sign a statement indicating that he or she has received the document and the date it was received.

· 102423(a)(4) – Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

Licensee has submitted proof of corrections for the above-mentioned citations, and the deficiencies were cleared.

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Pedro Solorio-Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: RAMIREZ VASQUEZ, ANNETT
FACILITY NUMBER: 434417746
VISIT DATE: 06/09/2025
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Licensee will stay in compliance with Title 22, Division 12, Chapter 3 regulations at all times.

Licensee was informed that training videos are available on the Community Care Licensing website at https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers

In addition, it was recommended that licensee connect with her local resource and referral agency for additional support and training. Licensee stated she already has contact information for her local resource and referral agency. Licensee was also informed about the Technical Support Program and Licensee agreed to seek services. Licensing Program Analyst Pedro Solorio-Gutierrez will make the referral to Technical Support Program.

Today, Licensee was informed that any further violations may result in a Non-Compliance Conference and possible referral to the Legal Division for Administrative Action. Furthermore, Licensee understands that any repeats of the above deficiencies within the 12 months will result in the issuance of civil penalties.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, no deficiencies are cited.

A signed of this signed report and appeal rights were provided to Licensee, Annett Ramirez Vasquez.


Susy Cervantes explained the purpose of the Informal Meeting and the administrative process. The Licensee was advised that continued non-compliance with Title 22 Regulations could result in their file being referred to our legal department for review and possible action against the license.

Facility representative understand that this Department will be increasing the monitoring of the facility.

Capacity increase is pending manager review.
NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Pedro Solorio-Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC809 (FAS) - (06/04)
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