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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625232
Report Date: 06/15/2022
Date Signed: 06/15/2022 02:44:55 PM

Document Has Been Signed on 06/15/2022 02:44 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ROMERO, AMBRIA FAMILY CHILD CAREFACILITY NUMBER:
376625232
ADMINISTRATOR:AMBRIA ROMEROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 450-4580
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
06/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Ambria RomeroTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Tyra Block conducted a Case Management Visit for the purpose of following up on previous visit where licensee received a Type A citation. LPA reviewed children's files to verify form LIC 9224- Acknowledgment of Licensing Report was signed by parents. Present with licensee were 11 children (3 infants) and 2 helpers. All adults had criminal background clearances and were associated to the facility. Facility was within ratio and capacity during this visit and forms were completed.

An exit interview was conducted with licensee, Ambria Romero and a Notice of Site Visit was provided. Licensee was advised the notice must be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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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