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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700230
Report Date: 04/08/2021
Date Signed: 04/08/2021 12:39:03 PM

Document Has Been Signed on 04/08/2021 12:39 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:RAMIREZ, JULIANAFACILITY NUMBER:
075700230
ADMINISTRATOR:RAMIREZ, JULIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 394-8787
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/08/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Juliana RamirezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Morgan Pringle met with applicant Juliana Ramirez to conduct an on site announced Pre-Licensing visit for a Change of Location. Present during the inspection was Applicant, Juliana Ramirez, her 4 year old son, and her fingerprint cleared husband.. The facility currently plans to operate Monday – Friday 7am -5pm. The applicant’s home was then toured for the health and safety inspection.

ON LIMITS AREA: Living room, downstairs bathroom, Kitchen, dining room and patio


OFF LIMITS AREA: Entire second floor and garage
ISOLATION AREA: Living room

The residence is a two story home consisting of four bedrooms, 2 bathrooms, kitchen, living room, dining room, laundry room, patio and garage.

The home has gained a fire clearance on 4/07/2021 from the San Ramon Valley Fire Protection Department. Per the clearance, the entire second floor and garage is “off-limits.”

The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas to the children. Applicant has stated that there are no firearms or pets in the home.

The home has one fully charged 2A10BC fire extinguisher, located in the kitchen. There is a pull station alarm in the entry way, and a working smoke detector/carbon monoxide detector in the living room and 2 more upstairs in the hallway. There are also working smoke detectors in each bedroom upstairs.

The applicant’s Health and Safety training has been completed and CPR and First Aid certificate is current with an expiration date of 6/01/2021. The home is equipped with central heating and air for proper ventilation. Applicant provided proof of immunization for pertussis, measles, and the flu shot.

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RAMIREZ, JULIANA
FACILITY NUMBER: 075700230
VISIT DATE: 04/08/2021
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LPA provided COVID-19 Self-Assessment Guide and all answers were discussed. COVID-19 postings were reviewed with applicant. LPA provided technical assistance regarding all COVID-19 policies and procedures.

Applicant was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed the applicant that all forms can be downloaded at www.ccld.ca.gov. Applicant was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed as well. Applicant was reminded that when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This home has been approved for the change of location on 4/08/2021.

This report was read and given to the applicant for a signature. This report shall remain on file for 3 years. Appeals Rights were provided and exit interview conducted.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
LIC809 (FAS) - (06/04)
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