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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364807190
Report Date: 05/03/2021
Date Signed: 05/05/2021 04:30:06 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/04/2021 and conducted by Evaluator Steven Montoya
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210304153341
FACILITY NAME:ROMERO FAMILY CHILD CAREFACILITY NUMBER:
364807190
ADMINISTRATOR:ROMERO, TINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 247-7772
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:14CENSUS: 5DATE:
05/03/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Tina Romero licenseeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Other: Uncleared adult living on the premise. Criminal Record Clearance
Other: Licensee falsifies documents. Conduct Inimical
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Steven Montoya followed up to finalize complaint investigation via telephone inspection on the above Family Child Care Home and spoke to licensee Tina Romero. The purpose was to inform licensee the outcome of the investigation is being concluded regarding the above allegations.

Based on observation of the premises, interviews with licensee/staff, parents, children and other relevant parties. The evidence did not reveal uncleared adult living on the premises, as well as licensee falsified documentation. Therefore the above allegation are unsubstantiated.

A copy of the report and appeal rights were reviewed with licensee telephonically, emailed to licensee. Licensee was advised to review, sign and return report for file.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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