197493193-9-6-2019-54-CC-DGIS-BFRS3Z-20190906133159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493193
Report Date: 09/06/2019
Date Signed: 09/06/2019 01:32:10 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:	BUSTOS CORTEZ FAMILY CHILD CARE		FACILITY NUMBER:	197493193
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	09/06/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Alin Bustos Cortez, Licensee		TIME COMPLETED:	01:45 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	Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced annual random inspection to the above facility. LPA met with Alin Bustos Cortez, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Luis Mendez, Licensee’s husband. Per Licensee, there are 9 children that are currently enrolled. A current children’s roster was available for review. There were 4 children present upon arrival, 1 was licensee's daughter. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room, and front yard (fenced). Main care is provided in the living room and 1 bedroom. The children use the bathroom next to the main care bedroom. Per Licensee, areas off limits to children and parents include: 2 bedrooms, 1 bathroom (locked) and kitchen (baby gate) (. The licensee provides food for children in care. LPA observed food available in the refrigerator. Hours of operation are Mon-Sun 23.5 hours. The licensee states that 2 adults and 1 child currently live in the home. 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 or weapons stored in the home. 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 cellphone that is used and the stays at the facility during operation hours. There is ventilation and heating (ceiling fans). LPA observed a wall heater that is inoperable. The following was observed and reviewed during this inspection: Detergents, cleaning compounds, medications, and other items which could pose a danger to children ------------------Page 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BUSTOS CORTEZ FAMILY CHILD CARE	FACILITY NUMBER: 197493193
	VISIT DATE: 09/06/2019

NARRATIVE

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were observed to be inaccessible to children. Poisons are locked in the kitchen which is off limits. The restroom that children use was observed to be clean and free of hazards.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 9/2018, as indicated on receipt. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. Children nap on mats in the main care bedroom. Infant play pen was stored due to no infants being in care today. Licensee was advised on safe sleep practices.

Currently, children are using the front yard for outdoor play. 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 did not observe any objects that can pose a danger to children on the outdoor yard. There are no pools or spas, or other bodies of water. Licensee has a cat that is in the house during operating hours.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 9/2021. .

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 does have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a Confidential Names List (LIC 811) 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. Disaster drill log is current.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. ------Page 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BUSTOS CORTEZ FAMILY CHILD CARE	FACILITY NUMBER: 197493193
	VISIT DATE: 09/06/2019

NARRATIVE

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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. LPA did not observe anyone smoking in the home.

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS, updated Parent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) and Never Shake a Baby pamphlet. LPA also consulted and explained Child Abuse Reporting.

Incidental Medical Services (IMS):
The licensee states that she will not 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.

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 Alin Bustos Cortez, Licensee, including, but not limited to Appeal Procedures and Appeal Rights. -----Page 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

LIC809 (FAS) - (06/04)

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