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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625232
Report Date: 09/20/2022
Date Signed: 09/20/2022 04:21:59 PM

Document Has Been Signed on 09/20/2022 04:21 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: 14CENSUS: 13DATE:
09/20/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ambria RomeroTIME COMPLETED:
04:25 PM
NARRATIVE
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On 9/20/22, Licensing Program Analyst (LPA), Tyra Block conducted an unannounced Case Management visit for the purpose of monitoring licensee's compliance with the noncompliance plan agreed to on 6/22/22. Present at the home when LPA arrived were 10 children including 4 infants with assistant Ms. Jackie. Ms.Jackie stated the children were napping and licensee had gone to pick up the other children from school. Licensee arrived after approximately 15 minutes with 3 additional children bringing the total census to 13 children. The other children present were over age 10. Licensee informed LPA she recently was granted guardianship of her nephews who also reside in the home.

LPA requested the self-assessment guide, facility roster, and recent forms LIC 9224 for newly enrolled parent's to acknowledge receipt of a Type A violation. The self-assessment guide was completed during the visit. A new facility sketch and LIC 279B (Children Residing in the Home), to add licensee's nephews, was provided to LPA during the visit.

Deficiencies were observed and cited on LIC 809-D during today's visit, a civil penalty was also assessed for repeat violation.
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Form LIC 9224 must be completed by parents and maintained in each child's file.

The Notice of Site Visit was provided and LPA advised it must be posted for 30 days. An exit interview was conducted with licensee Ambria Romero and a copy of this report was also provided.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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Document Has Been Signed on 09/20/2022 04:21 PM - It Cannot Be Edited


Created By: Tyra Block On 09/20/2022 at 04:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ROMERO, AMBRIA FAMILY CHILD CARE
FACILITY NUMBER: 376625232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/21/2022
Section Cited
CCR
102416.5(d)(2)

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102416.5(d)(2)-Staffing Ratio and Capacity: For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home... shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met. This requirement is not met as evidenced by:
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Licensee stated she will utilize an alternative method for afterschool pick up and fourth infant will cease attendance until 2nd birthday. Child was already scheduled to not attend Wednesday and Thursday. Licensee provided a written plan to stay in compliance and not accept infants if she will be out of ratio.
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Based on observation and interview licensee's assistant was left alone with 10 children including 4 infants, the total children present after licensee arrived were 13 children. This poses an immediate health and safety risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Tyra Block
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022


LIC809 (FAS) - (06/04)
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