Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413641
Report Date: 11/10/2016
Date Signed 11/10/2016 10:13:39 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROMERO, OLGA PATRICIAFACILITY NUMBER:
434413641
ADMINISTRATOR:ROMERO, OLGA PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 913-6105
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 11DATE:
11/10/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Olga Patricia RomeroTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Mel Matos conducted an unannounced random visit to the home today. LPA met with Olga Patricia Romero, Licensee, and explained the nature of today's visit to her. LPA also observed two adult assistants and 11 day care children (2 infants & 9 preschool) in the home during today's visit. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. The adults that reside in the home are the Licensee and her spouse. Licensee certifications for CPR and First Aid are current and expire on July 13, 2017. Licensee's spouse's CPR & First Aid certifications are current and expire on October 31, 2017. Licensee's adult assistant's CPR and First Aid certifications are current and expire on July 26, 2018 and September 27, 2018.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's visit. Last fire/disaster drill was conducted in October 2016. The Licensee has a working telephone in the home. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. Off limit areas in the home: Room 2, one bathroom, seven locked kitchen cabinet doors, laundry room, barricaded fireplace (located in the living room), and attached garage. There are no stairs inside the home. Off limit areas outside the home: right side yard.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are stored in the laundry room inaccessible to children. LPA advised the Licensee of the new immunization requirement (pertussis, measles, and flu vaccines) for all Licensees and staff that work directly with the children.


REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 11/10/2016):
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2016
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROMERO, OLGA PATRICIA
FACILITY NUMBER: 434413641
VISIT DATE: 11/10/2016
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 11/10/2016):


A review of records on 11/10/2016 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period. A reminder to Licensee regarding her oldest son who will be turning 18 in September 2015 and that he will need to obtain the criminal record and child abuse clearances within 30 days of turning 18 years of age.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with at least one qualified assistant present. The Licensee states that she does not transport children via vehicle; however, understands that children cannot be left in parked vehicles unattended at any time.

Licensee advised LPA that she will be closed from December 23, 2016 until January 2, 2017 for the Christmas/New Year holiday break.

No deficiencies issued during today's visit.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2