198002085-1-23-2020-54-CC-AJLO-BL4RE5-20200123115659

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198002085
Report Date: 01/23/2020
Date Signed: 01/23/2020 11:57:12 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:	CORTEZ FAMILY CHILD CARE		FACILITY NUMBER:	198002085
ADMINISTRATOR:	CORTEZ, G. & O.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 863-2361
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	14	CENSUS: 3	DATE:	01/23/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Oscar & Gloria Cortez, Licensees		TIME COMPLETED:	12:15 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 An unannounced Annual Random Inspection was conducted by Licensing Program Analyst (LPA) A. Lucero. LPA met with licensee Oscar Cortez. Licensee Gloria Cortez was unavailable at the initial start of the inspection. LPA was taken on a guided tour of the indoors and outdoors of the home by Licensee Oscar Cortez. This is a single story, four bedroom, two bathroom home. Per licensee Oscar Cortez, currently residing in the home are five adults and no minors. Present at the time of inspection in an off-limits bedroom was Licensee's son-in-law. LPA did not observe son-in-law to be caring for children. Licensee Gloria Cortez arrived at 10:47am. Upon LPA's inspection of the home, LPA observed infant #1 asleep in a bouncer. LPA advised Licensee Oscar Cortez that bouncers, and items related to bouncers, were prohibited in the day care home. LPA also observed infant #1 to be too big for the bouncer they were asleep in as LPA observed the infant's feet extend pass the bouncer. LPA also observed infant #2 in a bouncer, but was not asleep. LPA obtained photo of infant #1 asleep in the bouncer, and photo of infant #2 in bouncer. Children are to receive safe, healthful, and comfortable accommodations, furnishing, and equipment. Licensee removed infant #1 from the bouncer and placed them in a cot to sleep, and removed infant #2 from the bouncer and place them into a play area. Areas accessible to children were inspected as follows: Living room that is dedicated to the caring of children, one hallway bathroom, part of the detached garage, and back yard. Areas off limits include: Kitchen, all four bedrooms, one master bathroom, front yard. Licensee states that there are no weapons or firearms on the premises. LPA did not observe swimming pools or spas on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors and carbon monoxide detectors are present in the facility but were not tested as there was a child asleep. Fire extinguisher has been serviced on April 2019.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

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: CORTEZ FAMILY CHILD CARE	FACILITY NUMBER: 198002085
	VISIT DATE: 01/23/2020

NARRATIVE

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—CPR Card valid until: 03/28/2020 for licensee Oscar Cortez
—Child Care Roster, Disaster Plan, and Children's Records were not available for review.

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

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 a 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.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

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: CORTEZ FAMILY CHILD CARE	FACILITY NUMBER: 198002085
	VISIT DATE: 01/23/2020

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A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.

Baby walkers, saucer chairs, bouncers or any similar items are prohibited. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA provided a complete packet of the Provider Information Network (PIN) 10-02-CCP dated February 20, 2019 regarding Safe Sleep Awareness Campaign during today’s inspection (SP) provided.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

· Dog(s) and/or pets should be isolated from children in care.
· It is recommended that First-Aid kits be available on premises.
· Outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

See deficiencies page for deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview, copy of report was given. Appeal rights (SP) were issued and discussed.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: CORTEZ FAMILY CHILD CARE	FACILITY NUMBER: 198002085
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/23/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/23/2020 Section Cited	1 2 3 4 5 6 7	Personal Rights To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. The requirement is not met as evidenced by: LPA observed infant #1 asleep in a bouncer
	8 9 10 11 12 13 14	and was too big for bouncer. LPA also observed infant #2 in a bouncer, but not asleep. LPA obtained photos. This is an immediate risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: CORTEZ FAMILY CHILD CARE	FACILITY NUMBER: 198002085
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/23/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/31/2020 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. The requirement is not met as evidenced by: no Roster available for review. Potential risk.
Type B 01/31/2020 Section Cited	1 2 3 4 5 6 7	Child's Records The requirement is not met as evidenced by: licensees did not have any records for the children present. Children have been enrolled more than a month. This is a potential risk.
Type B 01/31/2020 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. The requirement is not met as evidenced by:
	8 9 10 11 12 13 14	There was no drills conducted and none for review. This is a potential risk.	8 9 10 11 12 13 14

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC809 (FAS) - (06/04)

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