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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010533
Report Date: 07/19/2024
Date Signed: 07/19/2024 11:25:11 AM

Document Has Been Signed on 07/19/2024 11:25 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198010533
ADMINISTRATOR/
DIRECTOR:		JIMENEZ, RAMONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3235607069
CITY:CUDAHYSTATE: CAZIP CODE:
90201
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
07/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Licensee Ramona JimenezTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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7/19/24 at 9:25 AM Licensing Program Analyst (LPA) Anthony Padilla conducted an Annual Inspection in English. LPA met with Ramona Jimenez, Licensee and provided the inspection Entrance Checklist, LIC 126. Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the hours of operation are Monday-Friday 7:00am-6:00pm. There were 8 children present. Also present was S.2, Licensee's assistant. All adults present have obtained the required Background Clearance. Individuals residing in the home were discussed and noted.

This is a single story, 3 bedroom/2 bath home. The main childcare area is in the den in the rear of home. Other areas accessible to children are: living room, dining room, kitchen, bathroom in the hallway and front yard patio.


Off limit areas, per Licensee and facility sketch are: Three (3) bedrooms, detached garage, laundry room/bathroom by kitchen, side and back yard. Off limit areas are made inaccessible by door safety locks and knobs. All off limit areas were observed to be closed.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. The bathroom that children use is located in the hallway observed to be clean and free of hazards.

LPA observed required posted documentation in facility entrance which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.



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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010533
VISIT DATE: 07/19/2024
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Licensee has firearm, 10:15 AM LPA observed to be in lockbox in off limit area (off limits bedroom) of home with ammunition stored and locked separately from firearm. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced 10/2023, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone.
LPA observed that detergents, cleaning compounds are in the kitchen inaccessible to children. The kitchen cabinets were observed with safety latched, keeping contents inaccessible to children in care. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in living room on couch, away from the other children. There are currently no pets in the home.

Infant Care: Licensee has one infant in care currently. LPA reviewed the new Safe sleep regulations with licensee, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.

Currently, children are using the front yard and patio for outdoor play. The outdoor play area was observed to be fence. LPA observed that the outdoor yard has toys and other materials for children to play with. Per licensee and facility sketch, the facility has no bodies of water. None were observed during inspection.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights.



Staff records were reviewed for approved Pediatric First Aid and CPR certification and will need to be renewed on 10/28/24, LIC-501: Personnel -Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. LPA reminded licensee that the required Mandated Reporter AB1207 must be renewed every 2 years and will need to be renewed on 9/8/24.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010533
VISIT DATE: 07/19/2024
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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Page 3

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010533
VISIT DATE: 07/19/2024
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During the exit interview, the LICENSEE Ramona Jimenez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Ramona Jimenez

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4