192006954-8-19-2021-33-CC-RLOZ-C62TXL-20210819150721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192006954
Report Date: 08/19/2021
Date Signed: 08/19/2021 03:07:35 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

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: 7	DATE:	08/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Martha Bustamante, Licensee		TIME COMPLETED:	03:20 PM

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	Visit conducted in Spanish At 1:40 pm Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced required 1 year inspection to the above facility. This inspection is following an attempted visit on 8/3/2021. Prior to entry LPA conducted a risk assessment, appropriate PPE was used. LPA met with Martha Bustamante, Licensee who guided analysts on a tour of the facility. Also present during this inspection, was Licensee’s adult daughter. Per Licensee, there are 9 children that are currently enrolled. A current children’s roster was available for review. There were 7 children present to being infants upon arrival. The licensee states that 2 adults currently live in the home. Per Licensee, she currently has one assistant. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home. This is a one story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room, daycare room, front yard and backyard (fenced). The children have access to the day care room which is located in the back of the house, 1 bathroom and backyard for play. Per licensee, areas off limits to children and parents include: 3 bedrooms, 1 bathroom, kitchen, living room and front yard. Areas inaccessible were observed to be locked, 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 during operation hours. There is ventilation and heating (units). The following was observed and reviewed during this inspection. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were not observed to be accessible to children. Poisons are locked in a locked shed located in the back yard. The restroom that children use was observed to be safe and sanitary. ----------------------------------------------------------- Pg.1 of 4 ----------------------------------------------------------------------

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUSTAMANTE FAMILY CHILD CARE	FACILITY NUMBER: 192006954
	VISIT DATE: 08/19/2021

NARRATIVE

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The valve on the required 2A10BC fire extinguisher indicates fully charged and was serviced on 10/21/2020, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 08/10/2021.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the day care room.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements in form of cots and cribs were observed.

Licensee states that she is currently caring for infants. LPA advised the licensee about the sleeping regulation and the LIC 9227 Individual sleeping plan. LPA observed the LIC 9227 in the infant’s file.

LPAs 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, husband smokes but he does not smoke in the home.

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.

Per licensee there is not pets in the premises.

The licensee is observed to be operating within the license capacity limitations.

At 2:14 pm children’s records were reviewed, including emergency information and were observed to be complete. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.
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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUSTAMANTE FAMILY CHILD CARE	FACILITY NUMBER: 192006954
	VISIT DATE: 08/19/2021

NARRATIVE

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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee’s and assistants CPR expires on 8/17/2023. There are first aid supplies available.

The licensee and her assistant do have proof of immunization against influenza, pertussis, and measles.

Mandated Reporter AB 1207 compliant Child Care Training Certificate is on file- expires on 3/112022

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

The following was discussed with the Licensee:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUSTAMANTE FAMILY CHILD CARE	FACILITY NUMBER: 192006954
	VISIT DATE: 08/19/2021

NARRATIVE

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LPA consulted with Licensee regarding COVID-19 health and safety guidelines on this date. COVID- 19 postings posted in the day care on this date.

During this inspection LPA discussed Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Martha Bustamante, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role and their signature on this form acknowledges receipt of these forms.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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