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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002634
Report Date: 06/15/2020
Date Signed: 06/15/2020 03:51:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BUSTILLO, FLOR MARIAFACILITY NUMBER:
384002634
ADMINISTRATOR:BUSTILLO, FLOR MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 410-7785
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:14CENSUS: 5DATE:
06/15/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee, Flor Maria BustilloTIME COMPLETED:
02:45 PM
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THE FOLLOWING INSPECTION WAS CONDUCTED VIA TELE-INSPECTION DUE TO THE COVID-19 SHELTER-IN-PLACE ORDER.

On 6/15/2020 at 2:20P.M., Licensing Program Analyst (LPA), Luis J. Gomez met with licensee, Flor M. Bustillo. Purpose of the inspection was explained and is for a scheduled Case Management inspection to add the backyard into the day-care. Present is the licensee and one helper caring for five children. All children present are preschool age. All adults in the home have criminal record clearances on file. LPA inspected the facility with licensee for health and safety hazards.

At 2:25P.M., LPA inspected the backyard area. LPA observed the backyard is completely enclosed. There are several tables, chairs and benches available for games and activities. All equipment inspected is in proper repair. There is sufficient shading available for the children. Licensee stated she plans to utilize the backyard in the evenings during pickup. There are no pool, ponds, bodies of water, hot tubs or spas accessible in the backyards area.

On 6/15/2020 at 2:32P.M., LPA observed a large aloe vera plant located in the backyard.

On 6/27/2020, Licensee submitted an updated facility sketch (LIC 999) to the licensing office.

Prior to area becoming incorporated, Licensee must complete the following:

-Remove or making all dangerous plants in the backyard area inaccessible

-Install child safety gates, making both side entries inaccessible

-Submit a current lease agreement showing control of the backyard area

This report must be available in the facility for public review. Notice of site visit was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2020
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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