274416019-10-9-2024-07-CC-TTRO-D9VVNB-20241009163452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416019
Report Date: 10/09/2024
Date Signed: 10/09/2024 04:35:07 PM

Document Has Been Signed on 10/09/2024 04:35 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:	ROBLEDO RAMIREZ, ROXANA		FACILITY NUMBER:	274416019
ADMINISTRATOR/ DIRECTOR:	ROXANA ROBLEDO RAMIREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 484-4083
CITY:	ROYAL OAKS	STATE: CA	ZIP CODE:	95076
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	10/09/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:09 PM
MET WITH:	Roxana Robledo Ramirez		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

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On 10/09/24 at 1:15 PM, Licensing Program Analyst (LPA) Teodoro Trujillo met with licensee Roxana Robledo Ramirez, for an annual inspection. Present with licensee were assistant, with seven children: five (5) preschool age, two (2) infants, two school age children arrived during site visit. Adults living in the home are licensee, her spouse, and one minor: 4-year-old minor child. Days and hours of operation are Monday through Saturday 06:00 AM to 06:00 PM.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 09/23/2024 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee Roxana Robledo Ramirez 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 inspected inside and outside of single-story home. Licensee home is on a sloped approximate 1 acre property. Licensee owns the home and Licensee states she has liability insurance with Assurance Childcare for a family childcare home (FCCH). LPA observed two infants napping in separate cribs during site visit. LPA observed a 3A40BC fire extinguisher last serviced 5/2/2024. Carbon Monoxide and smoke detectors are operable. LPA observed no wall heaters in the home. LPA observed a barricaded electric fireplace in the home. Licensee stated there are no firearms/weapons in the home. Sharp objects, medicines, poisons, and cleaning supplies are inaccessible to the children. Backyard is fenced. Off limits indoor: master bedroom with master bath, two bedrooms, and the attached garage. Off Limit outdoor: all of the gated rear back yard. Licensee states she has a vaccinated dog in the home. Licensee uses the outside front yard for children.

Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to her license. Licensee stated she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Continues report dated 10/09/2024 pg. 1/3

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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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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: ROBLEDO RAMIREZ, ROXANA	FACILITY NUMBER: 274416019
	VISIT DATE: 10/09/2024

NARRATIVE

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Continuation of report dated 10/09/2024 pg. 2/3

LPA observed a current roster of the children. LPA observed a fire and disaster drill log last performed on 09/03/2024. LPA reviewed 6 children’s files and observed all required documentation was in compliance. Infant individual sleeping plan (LIC 9227) for each infant under 12 months was discussed. LPA observed licensee completed Mandated Reporter Training on 11/28/22 and assistant 8/10/24. Licensee has Pediatric CPR/1^st Aid expiring on 04/04/2025 and assistant 6/20/2026. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is current for licensee, and all adults residing in the home.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS currently. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA discussed the safe sleep regulations with licensee Roxana Robledo Ramirez 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 Roxana Robledo Ramirez] 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.

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 Roxana Robledo Ramirez 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.

Continues report dated 10/09/2024 pg. 2/3

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROBLEDO RAMIREZ, ROXANA	FACILITY NUMBER: 274416019
	VISIT DATE: 10/09/2024

NARRATIVE

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Continuation of report dated 10/09/2024 pg. 3/3

During the exit interview, the Licensee Roxana Robledo Ramirez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Type A Deficiencies were cited today. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

Type A deficiencies were cited during today's visit. LPA Teodoro Trujillo informed licensee Roxana Robledo Ramirez that this report dated 10/09/2024 document(s) 1 (one) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Teodoro Trujillo informed the licensee Roxana Robledo Ramirez to provide a copy of this licensing report dated 10/09/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee Roxana Robledo Ramirez.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/09/2024 04:35 PM - It Cannot Be Edited

Created By: Teodoro Trujillo On 10/09/2024 at 04:27 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROBLEDO RAMIREZ, ROXANA	FACILITY NUMBER: 274416019
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102425(b)

Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in Child 1 (C1) and C2 were napping in a crib with a blanket, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/10/2024
	Plan of Correction
1 2 3 4	Licensee will submit a written statement of her understanding of CCR 102425(b) by close of business to the San Jose Regional Office 10/9/24.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Susy Cervantes

LICENSING EVALUATOR NAME:

Teodoro Trujillo

LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC809 (FAS) - (06/04)

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