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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629792
Report Date: 04/05/2024
Date Signed: 04/05/2024 04:42:01 PM

Document Has Been Signed on 04/05/2024 04:42 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ROMERO, AMBRIA FAMILY CHILD CAREFACILITY NUMBER:
376629792
ADMINISTRATOR/
DIRECTOR:		AMBRIA ROMEROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 857-6259
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
04/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:01 PM
MET WITH:Ambria RomeroTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 4/5/2024, at 3:01 p.m., Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management inspection. LPA met with Licensee, Ambria Romero and accompanied by licensee proceeded to tour the facility. Also present was Licensee's Assistant, Jamie Dodge. There were 10 children present, four (4) of whom are infants.

During the inspection, LPA Williamson observed Child #1 (C1) asleep in the off limits master bedroom, with the door closed. LPA's review of records for C1 determined that on 4/5/2024,15 minute sleep checks were not being conducted. LPA's review of files for licensee's assistant, Jamie Dodge was incomplete for Mandated Reporter Training which expired on 5/27/2023.

During the inspection, LPA reviewed and obtained pertinent documentation and reviewed PIN 20-24-CCP Safe Sleep Regulation.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited. See LIC809 D.

Exit interview was conducted with Licensee, Ambria Romero and a copy of this report, Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 04/05/2024 04:42 PM - It Cannot Be Edited


Created By: Vicky Williamson On 04/05/2024 at 03:20 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: 376629792

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/05/2024
Section Cited
CCR
102425(j)(5)

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Infant Safe Sleep The provider shall supervise infants while ...sleeping... If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.
This requirement is not met as evidenced by:
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Licensee removed C1 from the bedroom and locked the doors during the time of inspection. LPA and Licensee discussed Infant Safe Sleep.
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Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 10 persons, as LPA observed C1 asleep in a play yard in an off limits bedroom with the door closed which poses a potential health, safety or personal rights risk to persons in care.
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Type B
04/12/2024
Section Cited
CCR102416.3(a)(6)

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Alterations to Existing Buildings or Grounds (a) Prior to making alterations... ... the licensee shall notify the Department ... (6) Any change from an area of the family child care home previously identified as "off limits" ...
This requirement is not met as evidenced by:
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Licensee stated that she will retrain employees and provide a plan on how she will ensure that her assistants are aware that off limit areas are not utilized for daycare children. Licensee stated that she will summary training, a plan and sign in sheet to the San Diego Regional Office, no later than 4/12/2024.
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Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 10 persons, as LPA observed C1 asleep in an off limits bedroom with the door closed which poses a potential health, safety or personal rights risk to persons 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:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/05/2024 04:42 PM - It Cannot Be Edited


Created By: Vicky Williamson On 04/05/2024 at 03:38 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: 376629792

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
HSC
1596.8862(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is ... employee of a licensed child day care facility shall complete the mandated reporter training...(a)...renewal mandated reporter training every two years ...
This requirement is not met as evidenced by:
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Licensee stated that she will assure that her assistant completes Mandated Reporter AB1207 Training and submit proof of training to the Department, no later than 4/19/24.
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Based on interview and record review, the licensee did not comply with the section cited above in that mandated reporter training for licensee's assistant expired on 5/27/23, which poses a potential health, safety or personal rights risk to persons in car
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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:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024


LIC809 (FAS) - (06/04)
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