Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411909
Report Date: 05/19/2015 12:00:00 AM
Date Signed 06/03/2015 10:17:48 AM

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:RAMIREZ, DIANAFACILITY NUMBER:
434411909
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
05/19/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Diana RamirezTIME COMPLETED:
05:00 PM
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(2) Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced case management visit to the home today in response to the Licensee's request to increase her licensed capacity. LPA also conducted an annual random visit. LPA met with Diana Ramirez, Licensee, and explained the nature of today's visit to her. LPA observed 6 day care children and licensee's 5 year old son and 16 year old son. Days and hours of operation are Monday - Saturday from 6:00 AM to 6:00 PM. Licensee, her husband and a tenant, Rosemary are the adults living in the home. Licensee's certifications for CPR and First Aid are current and expire on June 28, 2015.

LPA toured the indoor and outdoor areas of the home during today's visit. The Licensee has a working telephone in the home and her cell number is (408) 612-6647. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Off limit areas inside the home are two bedrooms (Rosemary's room & master bedroom) & bathroom in master bedroom. LPA observed that the backyard is fenced. The play structure is bolted to the ground and safe for the children.

LPA observed a fully charged 3A40BC, fire extinguisher, working smoke detector, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Licensee talks to children as form of discipline and understands children's personal rights should not be violated.
- Fire Clearance was approved May 18, 2015.

A review of staff records on May 19, 2015 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
No deficiencies cited during today's visit.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2015
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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