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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216574
Report Date: 04/07/2023
Date Signed: 04/07/2023 12:27:39 PM

Document Has Been Signed on 04/07/2023 12:27 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:RAMIREZ FAMILY CHILD CARE HOMEFACILITY NUMBER:
406216574
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Vanessa RamirezTIME COMPLETED:
11:17 AM
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On 4/7/23, at 9:30 AM, Licensing Program Analyst (LPA) Elvin Baddley and LPA Dixie Wright conducted an announced Prelicense Inspection of the abovementioned residence and met with Applicant Vanessa Ramirez. LPAs informed Applicant of the nature and purpose of the inspection. Applicant informed LPAs of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 7:30 AM--4:30 PM, Monday- Friday. Applicant also intends to care for children 2 years of age to -4 years of age. LPAs note no children are in care at the time of the inspection.

LPAs, in the company of Applicant, toured the interior and exterior of the residence in its entirety. The home to be used for care is a detached two bedroom, one bathroom single story dwelling located in the rear of the property. The aforementioned has a play yard to the rear. The home in the front of the property (three bedroom, two bathroom) is exclude from care.

LPAs observed the residence to be clean and orderly. The residence has spacing and ventilation for children in care. The residence has no fireplace. However LPAs observed an open face heater which was screened by a heater cover. The bathroom to be used for children care is observed to be clean and free of toxins. Medication is located in the exclude home which is inaccessible to children in care. Sharps in the residence are located in a secure kitchen drawer. Cleaning compounds are secured in an elevated shelf in a secure kitchen cabinet.

LPAs observed a fire extinguisher (2A10BC) in the residence which was serviced 3/17/23. LPAs reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has numerous smoke and carbon monoxide detectors. A combination smoke/carbon monoxide detector was tested at 10:08 AM and found to be operable.

The play yard is enclosed by chain link fencing. Footing in the area is made up of various surfaces. The fences entry/exit gate is secured. Toys and play equipment in the area are age appropriate. LPAs observed (CONT. LIC 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: RAMIREZ FAMILY CHILD CARE HOME
FACILITY NUMBER: 406216574
VISIT DATE: 04/07/2023
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no bodies of water on site.

LPAs record review revealed Applicants' Mandated Reporter training was completed on 7/14/21 (expiration 7/14/23), and Pediatric CPR/First Aid (EMSA approved) was completed on 2/22/23 (expiration 2/22/25). Applicant completed Preventative Health Training on 12/17/22. LPA reminded Applicant of obligation to maintain current training and certifications. LPAs reviewed Applicant's control of property document (Lease Agreement). Applicant does not have liability insurance for the home as of yet. LPAs provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Applicant informed LPAs no ammunition or firearms are on site.

LPAs reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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. 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 Homes and the ADA, available at: http://www.ada.gov/childqanda.htm

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Applicant 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

(CONT. LIC 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: RAMIREZ FAMILY CHILD CARE HOME
FACILITY NUMBER: 406216574
VISIT DATE: 04/07/2023
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equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant Vanessa Ramirez. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 4/7/23.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC809 (FAS) - (06/04)
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