197493193-2-10-2020-54-CC-DGIS-BLNRB7-20200210115215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493193
Report Date: 02/10/2020
Date Signed: 02/10/2020 11:52:23 AM

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: 3	DATE:	02/10/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Alin Bustos Cortez		TIME COMPLETED:	12:10 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 case management inspection to the above facility on 2/10/20 on 10:50 AM. LPA met with Alin Bustos Cortez, Licensee, who guided analyst on a tour of the facility. The purpose of this inspection is due to licensee’s request for a capacity increase on 9/10/19. Currently, the licensee’s capacity is eight. Licensee wishes to increase to a capacity of fourteen. Per Licensee, family members residing in the home are 2 adults and 2 child. Per licensee, operation hours will be Monday to Sunday 23.5 hours. There were 3 children present upon arrival. one daycare child and licensee's two children. Also present during inspection was S1. A current children’s roster was available for review. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room, front yard and backyard(fenced). This property is a duplex, licensee lives in the front house. Back address is 1342 Exposition Blvd. Per Licensee, main care areas include the living room and 1 bedroom. The children use the bathroom next to the main care bedroom. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell), ventilation and heating (ceiling fans). LPA observed a wall heater that is inoperable. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The Licensee states that there are no poisons at the facility. The Licensee was advised that any poisons must be locked with a key or combination lock. The valve on the 2A10BC fire extinguisher indicates fully charged, as indicated on receipt submitted or service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Based on the Facility Sketch submitted, areas off limits to children and parents are: 2 bedrooms (locked), 1 bathroom and kitchen (gated). Licensee states that the rooms will stay locked during the hours of operation. ---------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

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: 02/10/2020

NARRATIVE

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The Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

The children will use the front yard for outdoor play, which was observed to be fenced. Outdoor play area was observed to be safe and free of hazards. LPA observed that there is 1 cat at the facility. The cat is kept indoors during operating hours. The Licensee states that there are no firearms, weapons or bodies of water on the premises.

There are toys available for children. The Licensee provides food for children in care during the inspection. If food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated. All required postings were observed. Children’s records were reviewed and are complete.

Licensee currently has one assistant. Licensee and assistant have completed required Pediatric First Aid and CPR which training which expire, 9/2021 and the Mandated Reporter Training. Licensee and assistant also have required immunization's. There are first aid supplies available.

Children nap on mats in the main care bedroom. Licensee states that currently they are only caring for their own infant. When infants are in care LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. A copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics was provided to the Licensee.

Incidental Medical Services (IMS):

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

This facility currently does not have any children on medication

LPA obtained an updated LIC 279B (Current children in your home) and LIC 999A (facility sketch)----------------------PAGE 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

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: 02/10/2020

NARRATIVE

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Health and Safety Code 1596.7996 Effective January 1, 2019, CCCs and FCCHs are required to provide parents and guardians of children enrolled, enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations and options for locations of affordable blood lead tests. 2019 Lead flyer Provided.

Licensee is seeking to provide care for 14 children 0-12 years old. A fire clearance has been granted as of 1/31/2020. Based on today’s observation a capacity increase will be granted upon Licensing Program Manager (LPM) approval.

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted with Alin Bustos Cortez, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

LIC809 (FAS) - (06/04)

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