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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423489
Report Date: 11/15/2021
Date Signed: 11/15/2021 06:46:21 PM

Document Has Been Signed on 11/15/2021 06:46 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ROMERO, MELITONFACILITY NUMBER:
013423489
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
11/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Meliton RomeroTIME COMPLETED:
07:00 PM
NARRATIVE
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On 11/15/2021, at approximately 2:30pm Licensing Program Analyst (LPA) Christina Uribe, and Licensing Program Manager (LPM) Chandra Charles, conducted a Unannounced Required 1 year site inspection. Upon arrival Licensee Meliton Romero, was not present. LPA & LPM met with assistants Gloria Campos. and Olivia Campos, both have finger print clearances. Also, present during inspection was (7) children which consisted of (2) infants, and (5) preschoolers. Assistant Gloria Campos,called Licensee Meliton Romero, and he arrived at the facility within 10 minutes.
Licensee operates the Family Day-Care facility Monday thru Friday, from 6:00am to 6:00pm.

A tour of the facility was conducted by (LPA) Uribe and Assistant Gloria Campos. Areas inspected: On-Limits -the living room area which has been converted into a children playroom, dining room area which has been converted into infant napping and diaper changing area, the hall way bathroom and the backyard area.
The following areas of the home is off-limits two bedrooms, and the master bathroom
The home is equipped with a functioning Carbon Monoxide & smoke detectors and a fully charged 3A40BC fire extinguisher.The home is neat and clean with heating and ventilation for safety and comfort.

Inside activities: the facility is equipped with ample toys and learning material for the children in care.
Backyard area: Is completely fenced, Licensee has ample amount of outside toys for the children,

Facilty records: 3:00pm (LPA) Uribe, reviewed (7) children facility files. And there were no facility files for the employees. Licensee and staffs CPR / First are current and will expire on July 1, 2023. Licensee and all employees do not have current Mandated Reporter certificates. Licensee and employees are in compliance with the immunization records as it pertains to all day-care providers.

***Continued on LIC 809C***
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ROMERO, MELITON
FACILITY NUMBER: 013423489
VISIT DATE: 11/15/2021
NARRATIVE
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During this site inspection Licensee was out of compliance with the following Title 22 regulation:
  • Mandated Reporter - 1596.8662 Availability of information regarding detecting and reporting ch.ild 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
  • Immunization - 102418 (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
  • Operation of a Family Child Care Home - 1596.841 Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
  • Personnel Records - 102416.1 (d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

Licensee or facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Meliton Romero.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 11/15/2021 06:46 PM - It Cannot Be Edited


Created By: Christina Uribe On 11/15/2021 at 05:26 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ROMERO, MELITON
FACILITY NUMBER: 013423489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2021
Section Cited
HSC
1596..8662

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1596.8662 Mandated Reporter
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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On or before 12/15/2021, Licensee will submit Mandated Reporter certificates for the licensee and all employees to Community Care Licensing Department by fax or mailed.
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Not meet as evidence by : LPA Uribe reviewed staff records and there was no current certificates available.
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Type B
12/15/2021
Section Cited
HSC1596.841

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Operation of Family Child Care Home

Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
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On or before 12/15/2021, Licensee will submit to Community Care Licensing a current facility roster.
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This roster shall be available to the licensing agency upon request.

Not met as eviidenced by: LPA Uribe reviewed Facility Roster and only 2 out of 7 children in care were recorded on the form.
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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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2021


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/15/2021 06:46 PM - It Cannot Be Edited


Created By: Christina Uribe On 11/15/2021 at 05:47 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ROMERO, MELITON
FACILITY NUMBER: 013423489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2021
Section Cited
CCR
102418(a)

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Immunizations: Prior to admission to a family day care home,children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

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On or before 12/15/2021, Licensee will submit to Community Care Licensing a current record of the child's immunization records.
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Not met as evidence by: LPA Uribe reviewed children's files and one child (C1) in care does not have any proof of immunizations on record.
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Type B
12/15/2021
Section Cited
CCR102416.1(d)

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All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

Not met as evidence by: LPA Uribe reviewed personnel files and found incomplete/missing personnel records that are required to be on record.
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On or before 12/15/2021, Licensee will submit to Community Care Licensing a current record of the complete personnel records requirements.

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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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2021


LIC809 (FAS) - (06/04)
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