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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409194
Report Date: 03/08/2023
Date Signed: 03/08/2023 02:33:26 PM

Document Has Been Signed on 03/08/2023 02:33 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, CRISTINAFACILITY NUMBER:
073409194
ADMINISTRATOR:ROMO, CRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 375-4269
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Cristina RomoTIME COMPLETED:
03:30 PM
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On 03/08/2023 at 1:30 PM, Licensing Program Analyst (LPA) Christina Watts conducted a follow up prelicensing inspection at Cristina Romo's large family home. LPA met with applicant, Cristina Romo and explained the purpose of this visit. Applicant was the only person present during inspection. Applicant and all adults in the home have criminal background clearance.

On 02/22/2023, LPA conduct a visit to facility for a prelicensing inspection. During inspection, LPA observed backyard of facility and backyard was not finished. Applicant stated she was going to have artificial turf installed. LPA informed licensee that the left side of the yard would have to be made inaccessible to children in care because left side of backyard was off limits. Applicant stated she would have gate installed in that area. During the inspection, LPA also observed that fire extinguisher did not meet the standard minimum requirement for licensing. Applicant stated she would update the fire extinguisher to meet licensing requirements.

During today's inspection, LPA observed the backyard. The backyard is fully fenced and safe for children in care. Backyard has artificial turf installed and a gate on the left side of the backyard to restrict access to children in care. LPA also observed during this inspection a fully charged 2A10BC fire extinguisher. Licensee has completed all plan of corrections.

AS OF 03/08/2023, APPLICANT HAS BEEN APPROVED FOR A LARGE FAMILY CARE CHILD HOME.

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: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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