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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700205
Report Date: 10/22/2024
Date Signed: 10/22/2024 10:46:57 AM

Document Has Been Signed on 10/22/2024 10:46 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:JIMENEZ, KARINAFACILITY NUMBER:
075700205
ADMINISTRATOR/
DIRECTOR:		JIMENEZ, KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 248-3508
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/22/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Karina JimenezTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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On October 22, 2024 at 9:15am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced for a plan of correction (POC) inspection to confirm corrections have been made for deficiencies cited during an Annual/Random Inspection conducted on 10/15/2024. LPA met with licensee Karina Jimenez. Present were 11 children and helpers Maria Caicado and Claudia Garcia Ortiz.

Section 102416.5(e) Staffing Ratio and Capacity was cited for the facility having 12 children (4 infants and 8 preschoolers) with only a helper present while the licensee was away at an appointment. LPA observed today there is 11 children (4 infants and 7 preschoolers) and two helpers in addition to the licensee. Facility is within its ratio/capacity limits today. LPA observed signed Acknowledgement of Receipt of Licensing Reports forms (LIC 9224) for children enrolled. The deficiency is cleared today.

Section 102417(g)(9)(A) Operation of a Family Child Care Home was cited for the facility not having a fire/disaster drill documented. Licensee submitted a copy of drill log on 10/21/24. The deficiency is cleared today.

Section 102425(j)(5) Infant Safe Sleep was cited for the door to infant napping room being closed while infants were sleeping. LPA observed the door open today. The deficiency is cleared today.

Section 102416(c) Personnel Requirements was cited for helper Maria not having First Aid/CPR during the time she was alone with the children. Per licensee, at this time Maria will not be taking the class as she will not be alone with the children. Additionally, helper Claudia has current First Aid/CPR training. The deficiency is cleared today.
No other deficiencies cited today. Copies of Letter of Deficiency Citations Cleared provided at visit. Exit interview conducted with licensee Karina Jimenez. Notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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