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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216045
Report Date: 09/02/2021
Date Signed: 09/02/2021 10:02:39 AM

Document Has Been Signed on 09/02/2021 10:02 AM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ROMAN FAMILY CHILD CAREFACILITY NUMBER:
406216045
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/02/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Elvira RomanTIME COMPLETED:
10:15 AM
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On 09/02/2021 at 9:05 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced follow up pre-licensing inspection. Prior to entering the facility, LPA conducted pre-screening COVID-19 questionnaire and based on Applicant's responses it was determined that the home is safe and free of any COVID-19 exposures. LPA met with Applicant, Elvira Roman and discussed the purpose of the visit.

LPA conducted a physical plant tour of the home and observed the following changes in the home.

LPA observed a carbon monoxide in kitchen of the facility. Applicant tested the detector at 9:08 AM and was operating. LPA observed COVID-19 related poster in the entrance of the home, inside the day care area of the home and in the children's bathroom.

Applicant stated that she recently ordered gates to place in the hallway but they have not arrived. For now, Applicant has placed child safety latches to all closets in the hallway and has added door safety knobs to all bedrooms making them inaccessible to children.

LPA and Applicant toured the granny unit that is located in the backyard of the home. LPA observed that there was random furniture that was not set up and black bags of random items such as family clothing, kitchen items etc. All items were in closed bags.

Applicant stated that no one lives in the granny unit however, her adult son Erick Salgado will be moving back to the area from Chicago and will be moving into the granny unit. Son is currently in the process of moving from Chicago to California. Applicant understands that adult son can not move into the granny unit, until individual is fingerprint cleared.

This home meets Title 22 Division 12 California Code of Regulations requirements of a Small Family Child Care Home (FCCH). Effective date of license is 9/2/2021.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2021
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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