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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409427
Report Date: 12/17/2024
Date Signed: 12/17/2024 02:48:00 PM

Document Has Been Signed on 12/17/2024 02:48 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ROMERO, KARENFACILITY NUMBER:
073409427
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
12/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Karen RomeroTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 12/17/2024, Licensing Program Analysts (LPAs), A. Hollinger and D. Campos conducted a Case Management - Licensee initiated inspection. Licensee has applied for a capacity increase from a small FCCH (max CAP 6) to a Large FCCH (max CAP 12). Present during today's inspection were licensee, her minor son and 6 children in care consisting of 3 infants and 3 preschool age children. Facility is in ratio today. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:30am to 5:00pm.

Community Care Licensing (CCL) has received an approved fire clearance on 11/7/2024.

This is a multi-level home which consists of a living room, kitchen, 3 bedrooms and one and a half bathroom.
The On-limit areas: The living room, kitchen, the bedroom on the main level and the bathroom located on the upper level hallway.
The Off- limit areas: are the 2 bedrooms on the upper level, the garage, laundry room and half bathroom on the ground level and a the garden area in the back yard divided by a small fence. Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision at all times. The fenced backyard will be used as the outdoor play area. LPAs observed a small shed and a small swing set for infants which is not anchored to the ground. Licensee stated she will not use the swings and will remove from the back yard as soon as possible. There are age appropriate toys in the home. There are no firearms in the home as stated by the licensee. LPA did not observe any hazardous materials or toxins accessible to children today. A sample of children's files were reviewed.
The home has a fully charged 2A10 BC fire extinguisher. The home is equipped with working smoke detectors and carbon monoxide detector. There is a working telephone in the home. The applicant’s CPR and First Aid certificate is current and expires 06/2025. Licensee completed mandated reporter training. Licensee is in compliance with immunization requirements. Safe sleep information was discussed with the licensee.
See 809-C for continuance-------------------------------------------------------------------------------
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ROMERO, KAREN
FACILITY NUMBER: 073409427
VISIT DATE: 12/17/2024
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The licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. The applicant was reminded of the responsibility as a mandated reporter.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, 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.

No deficiencies observed at this visit.

The licensee is now approved for a capacity increase to operate as a large family day care home with a maximum capacity of 12. Licensee understands that a Landlord Consent form LIC9149, an application and appropriate fee is required in order to operate at the max CAP of 14.

A Notice of Site Visit was provided and must remain posted for 30 days.

Exit interview conducted and report reviewed with licensee Karen Romero.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC809 (FAS) - (06/04)
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