Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619026
Report Date: 05/31/2019
Date Signed: 05/31/2019 01:23:16 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: 4DATE:
05/31/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Elsa Romo-FloresTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kristal Goodell conducted an Unannounced Annual Random Inspection. Upon arrival, LPA met with licensee's husband and assistant. LPA observed four children present. All individuals subject to criminal background review have obtained a criminal record clearance. Later during the inspection, licensee arrived. Hours of operation are Monday- Friday, 5:30am-5:30pm.

Inspection was conducted in all areas accessible to children. Off-limits areas include the entire upstairs. LPA observed gate below the stairs. LPA verified phone number. LPA also observed a 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. No weapons in the home, poisons or bodies of water. No children were observed in parked cars. Outdoor play space was fully fenced with two locked sheds. Licensee acknowledged that 100% supervision is required in unfenced areas.

Children's records were reviewed which included the Emergency Information and immunization records. LPA also observed fire drills are conducted once a month and child roster (LIC9040). LPA verified preventative health and safety certificate. LPA also observed licensee's pediatric CPR and first aid certification was expired. LPA also learned that the two adults present with the children did not have current CPR and 1st aide which poses a potential risk to children in care. Licensee acknowledged that a licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, or when children are off-site of the facility for facility activities. During inspection, Licensee provided LPA proof of enrollment for all adults present to obtain CPR and 1st certification. Report continues on LIC 809-C
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
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 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2019
Section Cited
HSC
1597.622(a)(1)
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Employees or volunteers at family day care home; immunization requirements; records; exemptions. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
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Licensee acknowledged requirement and stated that proof will be submitted to LPA by POC due date 6/28/19.
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Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met due to proof of immunzitions named above were not provided for licensee and adults providing care during inspection.
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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: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2019
Section Cited
CCR
102416(C)
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Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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Licensee acknowledged requirement and provided proof of enrollment for all adults present during inspection to obtain CPR and 1st aide. Proof of completion will be submitted to LPA by POC due date 6/28/19.
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during inspection LPA learned that the licensee and two adults providing care to children during inspection did not have current CPR and 1st Aide.
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Type B
06/28/2019
Section Cited
HSC
1596.8662
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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion.
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Mandated Reporter Training was discussed and licensee stated proof of completion will be submitted to LPA by POC due date 6/28/19.
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This requirement is not met due to during inspection LPA did not observe proof of completion for mandated reporter training for licensee and two adults present and providing care to children during inspection.
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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: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 05/31/2019
NARRATIVE
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Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, forms, self-assessment guides, legislation and regulation information.

Title 22 deficiencies cited on the attached LIC 809D. This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit issued and remain posted for 30 days. Licensee acknowledged that a copy of this report will remain on file for a period of three years for public review upon request. Appeal Rights were also issued and discussed.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 05/31/2019
NARRATIVE
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Effective September 1, 2016, immunizations for adults providing care and supervision is required to be on file. LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against, Pertussis, Measles and Influenza. LPA advised licensee that staff can sign a declaration to be exempt from the influenza vaccinations however; Pertussis and Measles are not exemptible. To be exempt from Pertussis and Measles staff must have a medical exemption signed by a licensed physician.

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.

The Mandated Reporter Training was discussed. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two year. Volunteers are encouraged but not required to take the training. In addition, effective January 1, 2018: Applicants must meet requirements as a precondition to licensure, existing licensees must meet requirements by March 30, 2018, new employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. Proof of certification was not provided during inspection.

Report continues on LIC 809-C
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5