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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020797
Report Date: 08/03/2021
Date Signed: 08/03/2021 03:23:41 PM

Document Has Been Signed on 08/03/2021 03:23 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CORTEZ & BUSTOS FAMILY CHILD CAREFACILITY NUMBER:
198020797
ADMINISTRATOR:D. CORTEZ & MAXIMO BUSTOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 384-5276
CITY:LOS ANGELESSTATE: CAZIP CODE:
90029
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/03/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensees Dolores Cortez & Maximo BustosTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Bardo Baluyot conducted an announced pre-licensing inspection today. LPA met with Applicants Dolores Cortez and Maximo Bustos who guided analyst on a tour of the facility. Adult daughter Alin Bustos who does not live in the home was present to translate. Those residing in the home are 3 adults (1 adult daughter) and a 17 year old daughter. Per applicant, operating hours will be Monday-Friday, 7 am - 6pm. (23 hours) Applicants state they want to care for children 0-13 y/o.

All areas identified on the facility sketch were inspected. This is a one story home which consists of 2 bedrooms, 2 full restrooms, kitchen, family room, living room, backyard (fenced), front yard (fenced) and garage. The family room in the back of the home is used for the day care. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There is an existing fireplace in the off limits living room that is adequately blocked. Per applicants, gas is turned off. LPA observed no gas fixtures installed.

Accessible to daycare children: 0 bedrooms, 1 restroom (has child size toilet) , family room, and backyard.

Off limits/inaccessible to daycare children: All bedrooms, 1 restroom, kitchen, living room and the garage. These areas are made inaccessible through child safety gates and safety knobs on the door knobs.

LPA inspected the areas to be used by the daycare children. The family room will be used for napping and napping equipment (cots) were observed. There is a crib/playpen available for infants. The children’s restroom was inspected. LPA did not observe any accessible hazards. There are safety latches installed on the sink cabinets and drawers and a safety gate is installed to make kitchen area inaccessible to children.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2021
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CORTEZ & BUSTOS FAMILY CHILD CARE
FACILITY NUMBER: 198020797
VISIT DATE: 08/03/2021
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LPA observed fire extinguishers (purchased/serviced on 6/1/21) in both the kitchen and family room. Knives are kept in a higher level cabinet above the refrigerator, which is latched. Medications are kept in an off-limits bedroom. The first aid kit is located next to the fire extinguisher. There is a smoke and carbon monoxide combination detector installed in the family room and kitchen. Applicant tested the detector and found it in operable condition.

LPA toured the outdoor play area (backyard) and inspected its safety and condition. Backyard is adequately fenced (block wall) and there is a swimming pool on the premises which is surrounded by a 6 foot tall metal fence which is kept locked at all times/when children are present via double key dead bolt. LPA observed it to open away from the pool and self-closing. Per applicants, they are willing to install a latch if necessary. LPA to verify prior to licensing. There are age appropriate toys and play equipment on site.

A parent board with required postings was observed at the entrance of the facility. Applicant obtained a certificate of completion for the Preventative Health and Safety training on 2/12/21. Applicants' CPR/1st Aid Certifications expire 6/2/23. The mandated reporter training was completed on 4/27/2021 and is on file.

The following was discussed with the applicant:


·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, TB clearance, and a valid criminal record clearance associated to the facility license.
·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.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CORTEZ & BUSTOS FAMILY CHILD CARE
FACILITY NUMBER: 198020797
VISIT DATE: 08/03/2021
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·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.
·Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.
·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, 24/7.
·Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
·No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
·Liability insurance was discussed with applicant.
·Mandated reporter training must be taken every 2 years.

During this visit, the LPA reviewed and issued Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up, light bedding.*A copy of the Safe Sleep Concepts were provided on this date.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov



SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CORTEZ & BUSTOS FAMILY CHILD CARE
FACILITY NUMBER: 198020797
VISIT DATE: 08/03/2021
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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

Per applicant, there are no other licenses held at this location. Applicant has a facility currently operating located 357 S Catalina #357 L.A. 90020 with Facility #198010920 since 8/10/04 which she will close pending licensure of nee location.

The following corrections must be completed prior to licensure and are due by: 8/11/2021
1. Latch and mesh installed on fence.

Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license. (If no corrections needed: Application is complete and facility in compliance. LPA is recommending facility be licensed for a large fcch.

Exit interview was conducted with Applicants, Dolores Cortez, and Maximo Bustos who are in agreement with the above. A copy of this report and all other licensing reports must be made available to the public for 3 years.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
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