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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001812
Report Date: 08/15/2024
Date Signed: 08/15/2024 11:50:46 AM

Document Has Been Signed on 08/15/2024 11:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BAUTISTA FAMILY CHILD CAREFACILITY NUMBER:
192001812
ADMINISTRATOR/
DIRECTOR:		BAUTISTA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 604-4425
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
08/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:04 AM
MET WITH:Maria Bautista, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs )Portia Bowden and Jeanette Estrada conducted an Unannounced Annual inspection to the above facility on 08/15/2024 at 10:00 AM. Upon arrival, LPAs disclosed the purpose of the inspection and met with Licensee, Maria Bautista, who guided the LPA on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. There were five day care children present during today’s inspection and one additional infant licensee states she is caring for today. Licensee states that there are currently seven children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 6:00 AM to 11:00 PM Monday thru Saturday. License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 5/16/2024.

This is a single-story home which consists of three bedrooms and two bathrooms, kitchen, living room, and playroom. There is a fireplace in the home that is barricaded by a gate and LPAs observed to be locked. Areas used by the children include the Living Room (located upon entry of the home), Bathroom 1 (located through right doorway next to Living Room), Kitchen/Dining Room, and Playroom ( in the rear of the home, located through Bedroom 1) and bedroom 1. Per Licensee, areas off limits to children and parents include two bedrooms and Bathroom 2 located inside a bedroom and garage that is accessible through playroom but door remains closed. LPAs observed a baby gate separating areas used by children and off-limits area and child safety door knobs on off limits rooms.

All areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPAs observed ceiling fans all through out the home. There is a working cellphone maintained in the home. LPAs observed electrical cover outlets all through the home. LPAs observed Living Room to have couches, TV hanging, bins filled with large legos and baby dolls available for children free of loose and sharp parts available for children
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Portia Bowden
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
VISIT DATE: 08/15/2024
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At 10:05am LPAs observed 3 children in care placed in high chairs eating in Dining Room/Kitchen. LPAs observed rectangular dining table and chairs, Per Licensee, they provide food for children in care and use Dining Room for eating.LPA's observed all kitchen cabinets to be locked and inaccessible to children.. LPAs observed a crib in corner of Living Room being used for storage. Licensee confirmed it is not currently in use. At 10:07 AM LPAs observed 2 preschool aged children in the rear playroom. LPAs observed age appropriate toys with no sharp edges. At 10:07 AM LPA's observed Bathroom 1 to have operable toilet and sink, general sanitation observed, adequate handwashing and toileting supplies, under cabinet sink to equipped with operable child safety lock, and to be free of hazards. All Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPAs observed cleaning solutions to be stored in under Kitchen cabinet sink with operable child safety lock and knives to be stored up high on top of refrigerator. Licensee states any medicine is stored in inaccessible kitchen cabinet. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock.

At 10:10 AM LPA's observed an enclosed backyard area with fencing to be close together with no spaces in between with a two story play structure that was bolted to the ground. Backyard is accessible through back door in play room. LPA observed plastic play house and large wooden play structure with slide and swings well maintained available for the children with turf grass below to cushion fall. LPA observed all trees, shrubs, and plants are maintained. Backyard was observed to be free of hazards and contained age appropriate toys with no sharp edges. Per licensee there is a dog in separate off limits area in the backyard that LPAs observed to be gated and inaccessible to children.

At 10:15 AM, LPAs observed fire extinguisher fully charged with service tag dated 02/24. At 10:17 AM, LPAs observed smoke and carbon monoxide detectors in operable condition.

At 10:20 AM LPA's observed an infant child in an offlimits bedroom with the door closed. Infant was placed in a stroller with a blanket and pacifier attached to their clothing. Licensee stated infant was not enrolled, they are only caring for infant for the day. Per Licensee authorized rep of infant advised to allow infant to sleep in the stroller as they prefer it over a crib or play yard. Licensee immediately removed infant from off limits room and from the stroller and placed infant with other children in care in the rear play room. Type B Deficiency will be issued regarding infant safe sleep.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Portia Bowden
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
VISIT DATE: 08/15/2024
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The Licensee has current Pediatric First Aid and CPR which expires 02/2025. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training on 05/09/24. At 10::30 AM, LPAs observed children's records to be complete.

Per Licensee, she does not provide incidental medical services at the moment, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs did not observe any bodies of water around the premises or firearms or weapons at time of inspection.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Portia Bowden
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812
VISIT DATE: 08/15/2024
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During the exit interview, Maria Bautista confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

One Type B deficiency is being cited today on page LIC 809D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Maria Bautista.

End of Report Page 4 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Portia Bowden
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/15/2024 11:50 AM - It Cannot Be Edited


Created By: Portia Bowden On 08/15/2024 at 11:21 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BAUTISTA FAMILY CHILD CARE
FACILITY NUMBER: 192001812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(5)
(j)The Provider shall supervise infants while they are sleeping and adhere to the following requirements:
(5) If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in infant was placed in offlimits bedroom with bedroom door closed, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Infant was immidiately removed from room and placed in playroom with other children in care.
Licensee will review infant safe sleep regulations and provide LPA's with Declaration stating she understands the regulations and will remain in compliance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Portia Bowden
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


LIC809 (FAS) - (06/04)
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