<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
192006954
Report Date:
12/31/2020
Date Signed:
02/24/2021 01:33:43 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK
,
CA
91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2020
and conducted by Evaluator
Roxana Lopez
PUBLIC
COMPLAINT CONTROL NUMBER:
33-CC-20201207104243
FACILITY NAME:
BUSTAMANTE FAMILY CHILD CARE
FACILITY NUMBER:
192006954
ADMINISTRATOR:
BUSTAMANTE, MARTHA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(626) 448-8406
CITY:
SOUTH EL MONTE
STATE:
CA
ZIP CODE:
91733
CAPACITY:
14
CENSUS:
0
DATE:
12/31/2020
ANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
Licensee, Martha Bustamante
TIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Children sustained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS REPORT WAS AMENDED- PLEASE SEE UNSUBSTANTIATED AMENDED REPORT 2/19/2021.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 981-3362
LICENSING EVALUATOR NAME:
Roxana Lopez
TELEPHONE:
(323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE:
12/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/31/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099
(FAS) - (06/04)
Page:
1
of
4
Control Number
33-CC-20201207104243
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
BUSTAMANTE FAMILY CHILD CARE
FACILITY NUMBER:
192006954
VISIT DATE:
12/31/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
THIS REPORT WAS AMENDED- PLEASE SEE UNSUBSTANTIATED AMENDED REPORT 2/19/2021.
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 981-3362
LICENSING EVALUATOR NAME:
Roxana Lopez
TELEPHONE:
(323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE:
12/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/31/2020
LIC9099
(FAS) - (06/04)
Page:
2
of
4