Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411909
Report Date: 01/10/2018
Date Signed 01/29/2018 01:27:29 PM

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:RAMIREZ, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 847-8560
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 5DATE:
01/10/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Diana RamirezTIME COMPLETED:
05:00 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 unannounced random visit to the home today. LPA met with Licensee, Diana Ramirez and explained the nature of today's visit to her. LPA also observed her husband, Abraham Lopez, 3 day care children and licensee's two children ages, 3 and 8 years old. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. Diana states herself, her husband and two adult children live in the home. Her son Javier Chavez is going through the exemption process. Diana's states her son, Abraham Lopez currently lives with his godmother and will be moving with her. LPA informed her that before he moves in he must be fingerprint cleared.

LPA inspected the indoor and outdoor areas of the home during today's visit. LPA reviewed a Child Care Facility Roster and fire disaster drill. Licensee has a new phone number (408) 612-6645. LPA provided her with the LIC 279 for update.
LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly for the children. Off limit areas in the home are entire 3 bedrooms and garage. Diana states she uses the garage to go out to the backyard.

LPA observed a fully charged 3A40BC fire extinguisher. working smoke and carbon monoxide detector. LPA observed a fenced backyard. The Licensee states that she does not have any weapons. Today LPA observed razors, lysol, fabuloso cleaner, and two large detergent bottles accessible to children. LPA reminded Diana that all detergents, cleaning compounds, medications, and other similar items are to be stored inaccessible to children.

(REPORT DATED 01/10/18 CONTINUES ON FOLLOWING PAGE)
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2018
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 3
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: RAMIREZ, DIANA
FACILITY NUMBER: 434411909
VISIT DATE: 01/10/2018
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
CONTINUATION OF PREVIOUS PAGE ( REPORT DATED 01/10/18

A review of staff records on January 9, 2018 indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Diana's son, Javier Chavez fingerprints are still pending.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with a qualified assistant present. The Licensee states that she does not transport children via vehicle; however, she understands that children cannot be left in parked vehicles unattended at any time.


LPA advised Ms. Ramirez of the required "mandated reporter" training that all staff will be required to complete starting January 1, 2018. LPA referred her to the Department website: www.ccld.ca.gov for additional information on the online training.
New failure to correct civil penalties were discussed with Ms. Ramirez.

LPA advised that licensing forms and all other information can be found at: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

LPA conducted an exit interview with the Licensee prior to the conclusion of today's visit. This visit was conducted in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS ALONG WITH A COPY OF THIS REPORT.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2018
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: RAMIREZ, DIANA
FACILITY NUMBER: 434411909
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/11/2018
Section Cited
CCR
102417(g)(4)
1
2
3
4
5
6
7
Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
1
2
3
4
5
6
7
Licensee removed items and stored them in off limits room. A written plan of correction stating she understands the regulation will be sent to LPA by tomorrow, January 11, 2018.
8
9
10
11
12
13
14
LPA observed razors, lysol, fabuloso cleaner and and laundry detergent accessible to the children in the bathroom sink and on the laundry area floor.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2018
LIC809 (FAS) - (06/04)
Page: 3 of 3