Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016669
Report Date: 02/25/2016
Date Signed 02/26/2016 01:38:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RAMSEY-RAY FAMILY CHILD CAREFACILITY NUMBER:
198016669
ADMINISTRATOR:RAMSEY-RAY,KIKANZA & GEOFFFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 296-6901
CITY:ALTADENASTATE: CAZIP CODE:
91101
CAPACITY:14CENSUS: 10DATE:
02/25/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Geoff Ramsey-RayTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Brandi Van Oosten conducted an unannounced random visit. LPA met with Geoff Ramsey-Ray, Licensee who guided analyst on a tour of the facility. Christine Martinez and Lyndsey Romero, Assistants was also present during this visit. There were 10 children present during this visit. Licensee states that there are 20 children enrolled (some part-time basis). Children’s roster was available and however is not current.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). This is a one story home which consists of 3 bedrooms, 3 bathrooms, den/activity room, kitchen, living room, dining room and backyard (fenced). The children use the den/activity room, which does have a restroom inside for children to use. Per licensee, areas off limits to children and parents include: 3 bedrooms, 2 bathroom, kitchen, living room and dining room, backyard directly behind the house (not fenced). The Licensees provide food for children in care.

The Licensee state that 3 adults and 3 children live in the home. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. The following was observed during this visit.

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger were observed to be inaccessible to children during this visit. The Licensee states that there are no poisons on the premises.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 02/17/15, as indicated on receipt taped on fire extinguisher. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke detector in the children's room was tested, and is in operable condition. Carbon monoxide detector is not available.
REPORT CONTINUES ON THE NEXT PAGE 1 OF 3
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2016
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RAMSEY-RAY FAMILY CHILD CARE
FACILITY NUMBER: 198016669
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2016
Section Cited
102417(g)(1)
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Fire extinguishers and smoke detectors shall meet State Fire Marshal standards.

The valve on the required 2A 10BC fire extinguisher indicates fully charged, however it was purchased on 02/17/15, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.
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Per Licensee, he will have the fire extinguisher serviced or will purchase a new one.

The Licensee will submit proof of correction by due date.
Type B
03/10/2016
Section Cited
102417(g)(8)
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Operation of a Family Child Care Home. All homes shall have a current roster of the children.

Licensee's roster is not current.
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Per License, he will update roster and will submit a copy as proof of correction by due date.
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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: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2016
LIC809 (FAS) - (06/04)
Page: 2 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RAMSEY-RAY FAMILY CHILD CARE
FACILITY NUMBER: 198016669
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2016
Section Cited
H&S 1597.543
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Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards. The department shall account for the presence of these detectors during inspections.

There is no carbon monoxide detector in the home.
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Per licensee, he will purchase a carbon monoxide detector and will submit proof of purchase as correction.
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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: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2016
LIC809 (FAS) - (06/04)
Page: 3 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RAMSEY-RAY FAMILY CHILD CARE
FACILITY NUMBER: 198016669
VISIT DATE: 02/25/2016
NARRATIVE
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The home was observed to be clean and orderly during this visit. There is heating and ventilation for safety and comfort. There are toys available for children.

The licensee understand that arrangements must be made for a substitute adult to care and supervise children when they are absent from the home. The licensee was observed to be operating within the license capacity limitations during this visit.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 02/12/16. The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expire on 03/16/2016. There are first aid supplies available.

Children’s records were reviewed, including but not limited to, Immunization Records and Notification of Parents’ Rights receipt for children present. LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List (LIC 811) documents the staff and/or children’s files that were reviewed during this visit.

There was NO ZERO TOLERANCE deficiencies cited during this visit. Zero Tolerance includes:
Absence of Supervision; Accessible Bodies of Water. No bodies of water on the premises; Accessible Firearms, Ammunition or Both. No firearms or weapons in the home; Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g)(2); The Presence of an Excluded Individual. No excluded individuals; Children are not left in parked vehicles. The facility does not transport children.

The following items were also discussed with licensee during this visit.
PETS: There is one dog on the premises.
POSTING REQUIREMENTS: Parent’s Rights Poster and the Facility License were observed not to be posted. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
REPORT CONTINUES ON THE NEXT PAGE 2 OF 3
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2016
LIC809 (FAS) - (06/04)
Page: 4 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RAMSEY-RAY FAMILY CHILD CARE
FACILITY NUMBER: 198016669
VISIT DATE: 02/25/2016
NARRATIVE
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INFANT CARE: The Licensee states that they do not care for infants.

Incidental Medical Services (IMS): The licensee states that medication is administered. However, inhaled medication and/or Epi-Pens are not administered at this time, as children enrolled do not require these services. LPA explained Incidental Medical Services to Licensee. LPA advised the Licensee that a plan of operation must be submitted once these medications start being administered. Please refer to Section 102417 for further information on regulatory requirements.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov
LPA discussed and provided the licensee with a packet with updated forms during this visit. Forms provided are as follows: 1) Forms/Records to Keep in your Family Child Care Home (LIC311D), 2) Updated Parents’ Rights Poster w/Complaint Hotline Information (PUB394), 3) Children’s Roster (LIC 9040), 4) Sample Disaster Drill Log, 5) Never Shake a Baby (PUB271), 6) Capacity Handout (Small & Large), 7) SIDS Information (5 pages listed above - infant care), 8) CCLD Winter Quarterly Update (pages 4-7 only, information includes: Fire Safety, Legislation Revision, New Immunization Requirements, New Appeal Process and New Health and Safety Training for Providers).

Based on this information, the following deficiencies listed on the attached LIC 809d are bing cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. The Notice of Site Visit (LIC 9213)must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Geoff Ramsey-Ray, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.
REPORT END 3 OF 3
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2016
LIC809 (FAS) - (06/04)
Page: 5 of 5