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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423489
Report Date: 11/02/2023
Date Signed: 11/02/2023 12:05:04 PM

Document Has Been Signed on 11/02/2023 12:05 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
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: 5DATE:
11/02/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Meliton Romero TIME COMPLETED:
12:20 PM
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On 11/2/2023 at 11:13 AM Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced increase of capacity inspection. LPA spoke to Licensee Meliton Romero ,and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Licensee and LPA toured the home inside and outside. At the time of the visit there were 5 children and 3 adults.

The home is a 3 bedroom, 2 bath, single story home. The licensee uses the living room, 1 bathroom, and backyard for the child care. three bedrooms, garage and kitchen are off limits for childcare. There are age appropriate toys,and furnishings in good condition and free of hazards. LPA did not observe any toxins/hazardous items accessible to children. The backyard is fully enclosed with a fenced wall. Cleaning supplies are kept high up next to the garage. Kitchen knives are stored in the pantry off limits to children in care. The bathroom to be used for children in care was observed to be clean and sanitary.

A regulation 2A10BC fire extinguisher was observed and fully charged. licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed smoke and carbon monoxide detectors are in working condition in the home. All adults in the home are fingerprint cleared. LPA observed the home to be orderly. No bodies of water were observed on site. Licensee stated that there are no guns or ammunition in the home.

The fire clearance for the increase in capacity was received on 9/15/23 and approved on 9/28/23



No deficiencies are being cited. This home is recommended for the capacity increase as of today's date (11/2/23). The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. This report shall remain on file for 3 years. Exit interview conducted with licensee. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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