<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416019
Report Date: 09/02/2021
Date Signed: 09/02/2021 01:13:24 PM

Document Has Been Signed on 09/02/2021 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:ROBLEDO RAMIREZ, ROXANAFACILITY NUMBER:
274416019
ADMINISTRATOR:ROXANA ROBLEDO RAMIREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 484-4083
CITY:ROYAL OAKSSTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/02/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Roxana Robledo RamirezTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Elizabeth Berumen conducted an announced pre licensing inspection and met with Applicant, Roxana Robledo Ramirez. Days and hours of operation will be Monday to Saturday from 5 AM to 7 PM. LPA observed Applicant's one year old daughter present during the inspection. Applicant understands that her daughter will count in her capacity until the age of 10.
Applicant, Roxana states that herself and her husband are the only adults living in the home. Both adults have obtained a criminal record and child abuse index clearance prior to today's tele-inspection.

LPA observed that the home is clean and orderly. LPA observed there are safe and age appropriate toys, play equipment, and materials for the children in the home. The smoke and carbon monoxide detectors were tested and proved to be working. LPA observed a 2A10BC fire extinguisher. LPA observed all cleaning compounds, sharp objects and medications are inaccessible to the children. Applicant understands that all poisons are to be locked.

The Applicant's CPR and First Aid certifications are current and expire on 05/31/2023. Applicant completed her Preventative Health and Safety Training including Nutrition/lead poisoning on July 26, 2021.

LPA inspected the indoor and outdoor areas of the home. The Applicant identified the off limit areas inside the home as the three bedrooms, master bedroom bath and garage. The Applicant states that she will use a space in the living room as a designated area where a child(ren) can be isolated if exhibiting signs of illness.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2021
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 2
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: ROBLEDO RAMIREZ, ROXANA
FACILITY NUMBER: 274416019
VISIT DATE: 09/02/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The backyard is off limits to children. Applicant will use fenced front yard for outdoor play space. No bodies of water were observed. LPA informed Applicant that smoking is prohibited in the home during day-care hours. Applicant states that her husband has a fire arm; the fire arm is locked in basement and stored in lock box. Ammunition must be stored separate from fire arm. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. Storage areas for poisons, firearms and other dangerous weapons shall be locked. In lieu of locked storage of firearms, the licensee may use trigger locks or remove the firing pin. Firing pins shall be stored and locked separately from firearms. Ammunition shall be stored and locked separately from firearms.
Form of discipline was discussed, Applicant understands that corporal punishment is not allowed. Applicant states she will use redirection as form of discipline and talk to children. Walkers and similar items are not allowed in child care. Children's personal rights should not be violated. LPA informed Applicant that she is to practice fire disaster drills and log them once every six months. Applicant is aware that she is to maintain a current child care facility roster. LPA reviewed safe sleep policies for the infants with the Licensee and provided Licensee "A Child Care Provider's Guide to Safe Sleep” document. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. A Family Child Care Home packet with updated Licensing forms will be mailed to the Applicant. LPA referred applicant to keep up to date with PINS on the department website. Please refer to PIN 2006 for current social distancing and COVID department guidelines. Applicants email address is roxy5281993@yahoo.com

Applicant's home received fire Marshall approval on 08/11/2021.
Before a large license (capacity 14) can be approved the following is required:
1. Barricade wall heater
2. LPA will conduct another inspection to ensure fire arm is stored according to 102417(g)(4).
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2