Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619026
Report Date: 04/18/2017
Date Signed: 04/18/2017 02:36:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ROMO-FLORES, ELSAFACILITY NUMBER:
343619026
ADMINISTRATOR:ROMO-FLORES, ELSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 564-9796
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:14CENSUS: 6DATE:
04/18/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Elsa Romo-FloresTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kiriko Pratt met with Licensee Elsa Romo-Flores for an annual/random visit and toured areas of the 5 bedroom/ 3 bathroom home accessible to children. Off Limits Areas include: entire upstairs. All adult residents have criminal record clearances. Licensee stated there were no new residents in the home. Staffing ratio and capacity limits were met per regulations. The FCCH Hours of Operation are Monday through Friday from 6:00 a.m. to 6:00 p.m.

LPA observed cleaning supplies, medications, knives, and other hazardous items were properly stored in areas made inaccessible to children. Licensee stated there were no weapons in the home. Fire extinguisher, smoke detector, and carbon monoxide detector met Title 22 regulations. Stairs are barricaded by a gate. Licensee maintains cell phone and landline service for the home. Home was clean and orderly with comfortable accommodations. Toys, play equipment, and materials were in working condition. Backyard is fenced, and there are no bodies of water on the property.



Report continues on LIC 809C
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Kiriko PrattTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2017
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ROMO-FLORES, ELSA
FACILITY NUMBER: 343619026
VISIT DATE: 04/18/2017
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LPA observed the following documents posted: License, Parents Rights Poster, and Emergency Disaster Plan. Licensee also maintains a current facility roster. Children's records were reviewed and included emergency contact information. Licensee's CPR and First Aid certification is current and CPR expires 12/2018. LPA informed Licensee of current laws, including changes to immunization regulations. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA provided the Licensing Agency website (www.ccld.ca.gov) to the Licensee, so she may obtain updated licensing information, provider information notices (PINs), regulations, and forms. An Exit Interview was conducted. A Notice of Site Visit was provided. No Title 22 deficiencies were cited during today's visit.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Kiriko PrattTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2017
LIC809 (FAS) - (06/04)
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