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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001812
Report Date: 09/17/2021
Date Signed: 09/17/2021 01:53:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BAUTISTA FAMILY CHILD CAREFACILITY NUMBER:
192001812
ADMINISTRATOR:BAUTISTA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 604-4425
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:14CENSUS: 6DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria Bautista, LicenseeTIME COMPLETED:
02:15 PM
NARRATIVE
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 THIS INSPECTION WAS CONDUCTED IN SPANISH
Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced required 1 year inspection to the above facility on 09/17/2021. LPA arrived at the facility at 9:15AM, identified self and met with Maria Bautista, Licensee, who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. LPA observed that also present during this inspection, was Cindy Bautista, Licensee’s Assistant. LPA observed 6 children upon arrival. Per Licensee, operation hours are 6AM to 6PM. There are 7 children that are currently enrolled. A children’s roster was available for review but it was not completely updated. LPA advised Licensee to update the roster during the inspection.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, den, front yard and backyard (fenced), garage, and wash room. The children use the bathroom in the hallway and living room. LPA observed that there is a fireplace in the living room and it is screened. Per Licensee, areas off limits to children and parents include: 2 bedrooms, one bathroom, the garage, and part of the backyard. The licensee provides food for children in care.

Individuals who reside in the home were noted and discussed. Per Licensee, they currently have one assistant.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee states that there are no firearms stored in the home. ------Page 1 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to LPA observing that in order for children to access the pay room children have to walk through Licensee's bedroom. Licensee's bedroom had medicines and ointments that a child can have access to which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2021
Plan of Correction
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Per Licensee, the room will be cleaned. Medicines and ointments will be removed. A picture of the cleaned room will be submitted by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above due to not having a fire and/or disaster drill documenting drills within the last 6 months not even the last 12 months, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2021
Plan of Correction
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Per Licensee, they will conduct a drill and document the time and date. A copy of the drill log will be submitted by POC due date.
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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above due to LPA observing that Child #6 was not placed in a crib or play yard as soon as they fell asleep and were left on the sofa which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2021
Plan of Correction
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Per Licensee, Licensee will ensure that infants will be placed in a crib, play yard, or cot/mat if they can pull themselves up already as soon as they fall asleep. A written plan will be submitted by POC due date.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above due to not having documentation and admitting to not documenting that they are checking for labored breathing, signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness, and the date and times of 15 minute checks which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2021
Plan of Correction
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Per Licensee, a log will be created and a copy will be submitted by POC due date.
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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
VISIT DATE: 09/17/2021
NARRATIVE
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline that is used. There is ventilation and heating. Safe toys play equipment and materials were observed.

While inspecting the home and walking to inspect the play room (den) at 9:29AM, LPA observed that children have to walk though Licensee's bedroom. LPA observed that Licensee had ointments and medicines that wer stored on top of dressers that are high for infants and toddlers but can be accessed by preschoolers and school-age children. LPA advised Licensee to remove, clean and organize items observed in bedroom. Per Licensee, they do not have any poisons stored at the facility and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 02/2021, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

Licensee states that she is currently caring for an infant that is over 12 months but under 24 months. Licensee states that infants sleep in the living room where they are constantly supervised. Upon arriving, LPA observed at 9:19AM that Child #6 was asleep on the sofa. Per Licensee, parent had just dropped off child and placed child on the sofa. LPA advised Licensee in regard to appropriate sleeping arrangements and cribs or play yards. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. Licensee did not have documentation to show 15 minute checks for sleeping infants. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee.
LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. ------Page 2 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
VISIT DATE: 09/17/2021
NARRATIVE
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Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA advised Licensee to cover the sharp metal edges observed. The licensee states that supervision is always provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 07/10/23. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee does have proof of immunization against influenza, pertussis, and measles.

LPA observed that the Licensee and assistant do have proof of the Mandated Reporter certificate on file.

LPA issued the LIC 859 and LIC 857 to the licensee which documents staff and children’s files reviewed during this inspection.



All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Licensee did not have a disaster drill log that documents a drill within the last 6 months not even within the last 12 months.

Licensee has a dog and cat. The cat stays in one of the off-limits bedrooms during hours of operation and the dog is in a dog run on the side of the house during operating hours.

LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.
-------Page 3 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
VISIT DATE: 09/17/2021
NARRATIVE
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LPA observed that Licensee's Emergency Disaster Plan has missing information and it is not completed. LPA advised Licensee to complete to form during the inspection. Parent’s Rights Poster and the Facility License were observed to be posted.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

The following deficiencies listed on the attached deficiency page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Maria Bautista. ----Page 4 of 4

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 7 of 7