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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423489
Report Date: 06/14/2023
Date Signed: 06/14/2023 10:59:02 AM

Document Has Been Signed on 06/14/2023 10:59 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
OAKLAND SOUTH EAST, 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: DATE:
06/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Olivia Campos Gloria Campos TIME COMPLETED:
11:15 AM
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 Licensing Program Analyst (LPA) Andrew Elliot and Licensing Program Manager (LPM) Wynn Norona met with facility staff Olivia Campos and Gloria Campos for an unannounced random annual inspection on 06/14/2023 at 9:00 am. LPA and LPM were allowed entry into the facility and began the inspection at 9:05 am. Upon entering the facility LPA observed that 5 children were present. LPA confirmed through child review that 4 preschool aged children were signed into the facility, in addition to 1 preschool aged child who was staff’s child.

LPA confirmed through file review that all adults requiring background clearance have been cleared and associated to this facility. LPA observed that the home is a single-story house consisting of 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, backyard, and garage. The hours of operation are


6:00AM- 6:00PM, Monday - Friday and occasionally Saturdays. The Facility has liability insurance through farmers insurance.

Day care area: Kitchen, living room, hallway bathroom#1 and back yard.
Off limit areas: Bedroom #1, Bedroom #2, Bathroom #2 and garage.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ROMERO, MELITON
FACILITY NUMBER: 013423489
VISIT DATE: 06/14/2023
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LPA inspected the house for health and safety hazards. Daycare Area is clean, orderly, and equipped with age-appropriate toys and equipment for children, indoors and outdoors. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher 3A40BC that meets the minimum requirements. There are ample of age appropriate toys that appear to be safe and in good condition. There is infant sleeping equipment available for each infant in care. There no pools, hot tubs or any other bodies of water during today's inspection. There are no firearms in the home as stated by the licensee. The fully fenced back patio/play area is available for children in care.

LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. Licensee have valid CPR. and will expire on 07/2023. Licensee provides daily snacks and lunch. Discipline policy is redirection. LPA reviewed children’s files. All the files are complete and up to date. Licensee and all employees have current Mandated Reporter certificates. All required postings are properly posted. LPA obtained a copy of the facility roster. This report must be available at Child Care and Group Home facilities for public review for 3 years.

During Inspection, Licensee 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
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ROMERO, MELITON
FACILITY NUMBER: 013423489
VISIT DATE: 06/14/2023
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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.
Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools
and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with staff Olivia and Gloria and Gloria Campos and licensee.

During your exit interview, LPA discussed the process of adding Glroia's name to the license. Gloria stated that she has already completed and submitted an application with included fees LPA explained the application process to Gloria and she confirmed that she understood. LPA will follow up moving forward regarding the submitted application.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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