Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624608
Report Date: 08/17/2015 12:00:00 AM
Date Signed 08/17/2015 04:15:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ROMANILLO, DIANA D FAMILY CHILD CAREFACILITY NUMBER:
376624608
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
08/17/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Diana RomanilloTIME COMPLETED:
04:20 PM
NARRATIVE
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(3) LPA Monica Cuddy conducted an unannounced inspection with the Licensee. The single story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present were the Licensee 6 day care children and licensee's daughter with her own children. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is a spa which is properly covered. There are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aid and CPR certifications expire on 3/16. Children’s records have up to date immunization records, and Notification of Parent’s Rights Receipts. Licensee has not maintained a current roster and has not conducted a disaster drill in the last 6 months. Licensee has applied for a large license. The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was received on 7/6/15. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include playroom and bathroom. Off limits areas include rest of the home and are inaccessible through use of security gates. The licensee has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. Licensee was also provided with information regarding SIDS and Shaken Baby Syndrome. Incidental Medical Services were discussed. A license for 14 children will be granted effective today. See LIC 809D for deficiencies cited.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2200
LICENSING EVALUATOR NAME: Monica CuddyTELEPHONE: 619-767-2249
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2015
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ROMANILLO, DIANA D FAMILY CHILD CARE
FACILITY NUMBER: 376624608
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2015
Section Cited
101217(g)(8)
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Operation of a child care home - licensee did not have a current faciltiy roster available for review.
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Licensee will provide copy of roster to the Department within 30 days
Type B
08/24/2015
Section Cited
102417
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Operation of a family day care home - licensee has not been conducting fire drills according to regulation.
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Licensee will conduct a fire/disaster drill and provide proof to licensing no later than 8/24/15.
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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: Carolina RamosTELEPHONE: (619) 767-2200
LICENSING EVALUATOR NAME: Monica CuddyTELEPHONE: 619-767-2249
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2015
LIC809 (FAS) - (06/04)
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