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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625232
Report Date: 12/14/2022
Date Signed: 12/14/2022 12:33:03 PM

Document Has Been Signed on 12/14/2022 12:33 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:
12/14/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Ambria RomeroTIME COMPLETED:
12:35 PM
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On 12/14/22, Licensing Program Analyst (LPA), Tyra Block conducted an unannounced Case Management visit for the purpose of quarterly monitoring of noncompliance plan agreed to on 6/22/22. Present today with licensee was assistant, Ms. Jaci and 11 children including 3 infants (under 24 months). Two infants were napping.

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. There were no new children enrolled since last visit in September. The self-assessment guide was completed during the visit. Licensee is in compliance, no deficiencies were cited during the visit. Licensee inquired about frequency of monitoring, LPA reviewed Noncompliance Plan and confirmed self-assessment and visit is to be conducted quarterly for the next 24 months.

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: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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