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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500199
Report Date: 09/17/2021
Date Signed: 09/17/2021 02:47:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ROMERO, MA DEL CARMENFACILITY NUMBER:
394500199
ADMINISTRATOR:ROMERO, MA DEL CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 854-9165
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:14CENSUS: 2DATE:
09/17/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ma Del Carmen RomeroTIME COMPLETED:
03:00 PM
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On 09/17/21 Licensing Program Analysts (LPAs) Fabiola Diaz and Elvira Sierra met with licensee Maria Del Carmen Romero for unannounced annual inspection. The facility hours of operation are 5am to 5pm Monday through Friday. Present in the facility were licensee’s adult daughter and two grandchildren.

The family child care home facility is two story family home with 4 bedrooms with 2 and a half bathrooms.
Today licensee updated her off-limit areas. Off limit areas: living room 2, entire second floor, garage, dog run (right side of backyard), and kitchen. Dining area will be left on-limits to use as a walk way to access the back yard. Licensee acknowledges that children may never enter these off-limit areas. The backyard is fenced. Licensee was notified that prior to use of any off limits area, the department must be notified.
A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. The first aid kit is located in the kitchen. Licensee stated she has not weapons in the home and no bodies of water were observed. Cleaning compounds and hazardous items were inaccessible to children. Safe toys and play equipment were observed. LPAs observed all the required postings. Licensee’s and 2 children’s files were reviewed and were complete.
LPAs observed the record of licensee’s immunization on file. Children's roster and fire drill log were up to date. Licensee had CPR/First aid card that expires on 7/1/22 and Mandated Reporter Training that expires on 1/8/22. Licensee understands training must be complete every two years.
Report continues on 809C................
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: ROMERO, MA DEL CARMEN
FACILITY NUMBER: 394500199
VISIT DATE: 09/17/2021
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Incidental Medical Services was discussed with licensee– IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with licensee 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 licensee 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 will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over, 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.

No Title 22 Deficiencies observed in the areas of today's facility evaluation. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Maria Del Carmen Romero.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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