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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400325
Report Date: 09/08/2023
Date Signed: 09/08/2023 12:06:37 PM

Document Has Been Signed on 09/08/2023 12:06 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ROMERO FAMILY CHILD CAREFACILITY NUMBER:
198400325
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
09/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee - Florencia RomeroTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management visit to the above mentioned address on 09/08/23 at 9:30 AM. LPA met with licensee, who guided LPA on a tour of the home. LPA observed 4 adults and 6 children present during inspection. Adult S5 was observed to arrive at the facility at 10:30 AM. LPA observed that 4 of the children present are infants. LPA confirmed ages of infants during file review. LPA advised licensee that a citation under California Code of Regulation section 102416.5(b)(2) will be issued. Individuals residing in the home have been noted and discussed. The applicant is requesting capacity increase to their family childcare home license. Per licensee, operation hours will be Monday through Friday, 6:30 AM to 9:00 PM. Applicant states that they will care for children 0 to 12 years old.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 4 bedrooms, 2 bathrooms, kitchen/dining room, living room, a detached garage, front yard and backyard (fenced). The off limit areas include 3 bedrooms, 1 bathroom, kitchen, front yard, detached garage, and part of the backyard area.

The main care area is located in the living room. LPA observed a wall mounted television, wooden cubby locker for children's personal belongings, a ceiling fan, 3 Cosco play pens, a children's rug, a window mounted air conditioning unit, a couch, age appropriate toys, child sized table and child sized chairs. Emergency Disaster Plan, Facility License, and Parents rights poster was observed to be posted next to the front door of the main care area. A tension gate was observed at the entrance of the hallway leading to the bathroom designated for children in care. The bathroom was observed to have an operable sink, toilet and faucet. The dining area was observed with a dining table and chairs. Another tension gate was observed at the entrance of the off-limits kitchen. Per licensee, she provides food for children in care. Licensee understands that any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated. The bedroom designated for children use was observed with a Cosco playpen, children's rug, sleeping cots, and additional age appropriate toys. The outdoor play area was observed to
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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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Document Has Been Signed on 09/08/2023 12:06 PM - It Cannot Be Edited


Created By: Randy Derraco On 09/08/2023 at 11:32 AM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 198400325

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2023
Section Cited
CCR
102416.5(b)(2)

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102416.5 Staffing Ratio and Capacity (b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time...(2)Six children, no more than three of whom may be infants. This requirement is not met as evidenced by:
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Based on observation, interview and record review, the licensee provided care for 4 infants and 2 toddlers which poses and immediate. Health, safety and/or personal rights risk to persons in care.
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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:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023


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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 198400325
VISIT DATE: 09/08/2023
NARRATIVE
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have perimeter fencing, shade, and children's outdoor play equipment. A yellow wooden gate was observed to be locked, separating the children's outdoor play area from the off-limits portion of the backyard. Per licensee there are no pets, there are no firearms or weapons stored in the home and there are no bodies of water. LPA did not observe any of the above items.

Areas that will be used by children were inspected for safety, comfort, cleanliness. LPA observed operable telephone service and ventilation. LPA observed a wall heater in the main care area. Licensee provided a service tag dated 12/03/20 that states "wall furnace off at house line per customer request". Per licensee, heat is provided by electric rotating heaters that are stored in the closet. Detergents, cleaning compounds and hazardous items that can pose a danger to children are made inaccessible in the off limits kitchen cabinet. LPA observed U-locks on cabinets in the kitchen. The licensee was advised that any poisons must be locked, not just inaccessible. LPA observed that the licensee has a 2A-10BC fire extinguisher in the home with a service tag dated 11/08/22. Smoke and carbon monoxide detector were tested and are operable.

LPA discussed the safe sleep regulations with licensees 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 licensees 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.

The licensee has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR. Licensee has proof of required immunization's. LPA observed that the Assistant has required training's and immunization records. There are first aid supplies available.

Incidental Medical Services (IMS):
This facility may provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 198400325
VISIT DATE: 09/08/2023
NARRATIVE
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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 advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov

Applicant is requesting a large family child care. Fire clearance was approved on 05/10/23. A large family childcare license may be granted upon Licensing Program Manager (LPM) Approval. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

Prior to approval, licensee must provide proof of the following:
-Assistant has taken measles vaccination. Documentation of vaccine must be kept in assistant's file at the family child care home.

LPA Randy Derraco informed co-licensees Florencia and Emmanuel Romero that this report dated 09/08/23 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Randy Derraco informed the licensees Florencia and Emmanuel Romero to provide a copy of this licensing report dated 09/08/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights provided and report was reviewed with the licensees Florencia and Emmanuel Romero

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC809 (FAS) - (06/04)
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