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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014050
Report Date: 12/07/2023
Date Signed: 12/07/2023 02:06:19 PM

Document Has Been Signed on 12/07/2023 02:06 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ROMERO FAMILY CHILD CAREFACILITY NUMBER:
198014050
ADMINISTRATOR:ROMERO, GENNYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 542-0455
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Genny Romero, LicenseeTIME COMPLETED:
02:15 PM
NARRATIVE
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An unannounced Case Management inspection was conducted on this date, 12/07/23 by Licensing Program Analysts (LPAs) Monique Ayala and Staicy Perry to verify that the licensee received and has abided by the following letter regarding Johnny Romero: ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION

Upon arrival LPAs met with Licensee, Genny Romero and the nature of the inspection was discussed.

LPAs advised Licensee that as of November 16, 2023, Johnny Romero is excluded from Romero Family Child Care Home and any other facility licensed by Department of Social Services. Licensee was advised that the immediate exclusion letter is a public document. The licensee was advised of the appeal process for this exclusion.

Licensee did not understand the letter as she stated it was vague. Licensee stated that Johnny has remained living at the facility as he is not present during the time the day care is operating. LPAs reviewed the letter with the licensee and informed the licensee that the excluded adult, Johnny Romero must not be present in the facility at all. Licensee stated that Johnny Romero will move out of the facility effective 12/07/2023.

Per licensee there are 12 children enrolled at the facility.

The licensee was advised that the following parent notifications are required for an excluded individual:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 198014050
VISIT DATE: 12/07/2023
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• Provide a copy of the Addendum to Notification of Parent's Rights (Regarding Removal/Exclusion) (LIC 995B Rev. 05/03) to one parent or authorized representative of every child currently in care within one day of receipt of the addendum from the Department.

• Obtain a signed and dated receipt from one parent or authorized representative that acknowledges that he/she was given a copy of the addendum specified in 102370.1(b)(2) and (2)(A). (LIC995B)

• Maintain copies of the signed and dated receipt (LIC995B) as required in Section 102370.1(b)(3) in each child's file. Copies shall be made available to the Department upon request.

The facility is being cited a Type A deficiency and will be given immediate civil penalties due to having Johnny Romero living in the home after being excluded. The licensee received the exclusion letter on 11/17/2023.

The facility will also be cited a Type B deficency for Reporting Requirements. The facility did not report an incident regarding a day care child.

Exit Interview conducted with Licensee. Notice of Site Visit (LIC 9213) posted and – must remain posted for 30 consecutive days. Failure to maintain posting as required will result in a civil penalty of $100.00. A copy of Appeal Rights was explained and provided.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/07/2023 02:06 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 12/07/2023 at 01:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 198014050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/07/2023
Section Cited
CCR
102416(d)(1)

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Personnel Requirements: Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall: Obtain a California clearance or a criminal record exemption as required by law or Department regulations
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Licensee, will have excluded audult Johnny Romero out of the facility by today 12/07/2023.
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This requirement was not met as evidence by: Based on interview with the licensee, the excluded adult Johnny Romero is still living in the home.
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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:Ana Chico
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023


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Document Has Been Signed on 12/07/2023 02:06 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 12/07/2023 at 01:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 198014050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
Section Cited
CCR
102416.2

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Reporting Requirements: The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). This requirement was not met as evidence by:
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Licensee will submit an incident report to the department by POC date (12/15/2023)
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Based on record review licensee did not report an incident that occurred with a day care child to the department.
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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:Ana Chico
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023


LIC809 (FAS) - (06/04)
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