073409194-2-22-2023-02-CC-CWAS-CPB45X-20230222174839

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409194
Report Date: 02/22/2023
Date Signed: 02/22/2023 05:50:14 PM

Document Has Been Signed on 02/22/2023 05:50 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ROMO, CRISTINA		FACILITY NUMBER:	073409194
ADMINISTRATOR:	ROMO, CRISTINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 375-4269
CITY:	HERCULES	STATE: CA	ZIP CODE:	94547
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/22/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Cristina Romo		TIME COMPLETED:	05:50 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	On 02/22/2023 at 1:30 PM, Licensing Program Analyst (LPA) Christina Watts conducted an announced Pre-licensing Inspection and met with Applicant Cristina Romo, who has applied for a Large Family Child Care Home with a capacity of fourteen (14). Living in the home are applicant, applicant spouse and applicant three minor children ages 15 and 4 years old. Applicant stated another minor child aged 8 years old will be present in the home during hours of operation however does not live in the home. Present during inspection was applicant and applicant's 15 year old minor child. Days and hours of operation will be Monday – Friday from 8:00 AM - 5:00 PM. Applicant completed 8 hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8 hour Pediatric CPR & First Aid Certificate that expires 08/2023, has documentation for Measles, Pertussis, Influenza opt out statement for the current flu season. Applicant and adults living in the home have Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant has completed and submitted certificate for Mandated Reporter training which expires 12/2023. Applicant rents the home and provided documentation to licensing. LPA reminded applicant that when care for more than twelve and up to fourteen is provided, applicant must notify parents and provide parents form LIC 9150 - Parent Notification of Additional Children in Care. Applicant will use the Affidavit Regarding Liability Insurance form to inform parents they do not carry a day care insurance. Applicant has a working telephone in the home. Fire Safety Clearance was granted to this facility by Inspector W. Lellis on 08/20/2021 by Contra Costa County Protection Department. This is a one story Home comprises of 3 bedrooms, 2 bathrooms, Living Room, Family Room, Kitchen, Breakfast nook, Dining room, Laundry Room, Attached garage, and backyardk. Areas on limits: Bedroom 3, Living Room, Family Room, Dining Room, Kitchen, Breakfast Nook, Hallway bathroom, and Center of backyard Off-Limit Areas: Master bedroom (bedroom 1), bedroom 2, master bathroom, Laundry Room, Right and left side of backyard, and Attached garage. Isolation Area: Bedroom 3 CONT ON PAGE 2

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ROMO, CRISTINA	FACILITY NUMBER: 073409194
	VISIT DATE: 02/22/2023

NARRATIVE

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LPA toured the indoor space of the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. LPA observed a screened fireplace in the living room that is locked and made inaccessible to children in care. LPA observed fully charged 1A10BC fire extinguisher. LPA informed applicant the minimum standard for fire extinguisher for licensing is 2A10BC. Applicant stated she will update the fire extinguisher. LPA observed a working smoke and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children. Door access to off limit areas are made inaccessible to children. LPA reminded appliant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Applicant states there are no firearms and ammunition stored in the home.

Outdoor Space: LPA toured the outdoor areas. LPA observed a safe and fully fenced backyard that is safe for children in care. LPA observed age appropriate toys for children to play with. LPA observed a locked shed in backyard. LPA observed an unfinished section in the middle of backyard. Applicant stated she will have artificial turf installed in the backyard. LPA informed applicant LPA will return to inspect backyard. LPA also observed the left side of the yard to be accessible to children in care. LPA informed applicant that left side of backyard must be made inaccessible to children in care. Applicant stated she will put a gate to make the area inaccessible to children in care. No bodies of water were observed in facility. Applicant stated she will use backyard and nearby park for outdoor activity. LPA reminded applicant when outside of facility, 100% supervision of children in care is required. Facility does not provide transportation for children, but applicant understands that children cannot be left alone, unattended in parked vehicles

Applicant understands that children's personal rights should not be violated. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be conducted once every six months and documented. A Family Child Care Home packet was provided to and reviewed with the Applicant.
*CON'T ON PAGE 3*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ROMO, CRISTINA	FACILITY NUMBER: 073409194
	VISIT DATE: 02/22/2023

NARRATIVE

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LPA discussed and reminded Applicant day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

LPA reviewed with Applicant the LIC311D, Forms/Records To Keep In Your Family Child Care Home, Children's Forms/Records, Facility Forms/Records, and Information to be Posted. This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with Applicant, and discussed the Child Care Licensing Safe Sleep web page 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 equipment.

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.

*CON'T ON PAGE 4*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ROMO, CRISTINA	FACILITY NUMBER: 073409194
	VISIT DATE: 02/22/2023

NARRATIVE

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Website links for provider resources:
Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.
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 or email:childcareadvocatesprogram@dss.ca.gov

The following items to be completed prior to licensure:
1) Completion of artificial turf in the center of backyard
2) Updated Fire Extinguisher

License will be pending until another prelicensing inspection visit is performed. License will be pending a final file review and manager approval.

Exit interview was conducted with Applicant, Cristina Romo and signed the report acknowledging receipts of documents.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

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