Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413641
Report Date: 02/01/2018
Date Signed 02/01/2018 10:15:29 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: 9DATE:
02/01/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Olga Patricia RomeroTIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Mel Matos met with Olga Patricia Romero, Licensee, for an unannounced annual/random inspection. LPA also observed Licensee's spouse, two adult assistants, and nine day care children (1 infant & 8 preschool) in the home during today's inspection. 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, Licensee's spouse, and Licensee's adult son. The Licensee, Licensee's spouse, and one adult assistant have current certifications for CPR and First Aid (exp: 10/26/2019). Licensee's second adult assistant has current CPR and First Aid certifications (exp: 07/28/2018).

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last fire/disaster drill was conducted on January 3, 2018. LPA reviewed twelve children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.

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.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 02/01/2018):
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2018
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROMERO, OLGA PATRICIA
FACILITY NUMBER: 434413641
VISIT DATE: 02/01/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 02/01/2018):

A review of records on January 26, 2018 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.

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.

No deficiencies issued during today's inspection.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and advised the Licensee of the required "mandated reporter" training that all Licensees and staff will be required to complete by March 31, 2018. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.


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: 02/01/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2018
LIC809 (FAS) - (06/04)
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