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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011108
Report Date: 08/02/2022
Date Signed: 08/02/2022 10:55:15 AM

Document Has Been Signed on 08/02/2022 10:55 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CORTEZ FAMILY CHILD CAREFACILITY NUMBER:
198011108
ADMINISTRATOR:CORTEZ, REYNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 771-6825
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Reyna Cortez-LicenseeTIME COMPLETED:
11:05 AM
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Due to technical issues, although annual inspection was completed on 7/27/22 from 9AM to 12:45PM LPAs were unable to issue the report, report was lost, and a written report was issued to Licensee.
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On 8/2/22 LPAs returned to issue report and deficiencies for the inspection below which was completed on 7/27/22. On 7/27/22 Licensing Program Analysts (LPAs) Jeanette Estrada and Austin Estrada conducted an unannounced required 1 year inspection at the above facility. LPAs met with the Licensee Reyna Cortez and informed her of the purpose for the visit. LPAs provided Licensee with a copy of the Facility Entrance Checklist. Licensee guided LPAs on a tour of the facility. There were 11 children present during the inspection. All residents were noted and verified. Also present was Adult 1-Licensee's daughter who was assisting for the day. Facility provides care to children ages 0 to 12. Facility is open 24 hours/ 7 days a week. Licensee was advised that care shall be provided for more than 24 hours.
This is a one story, 4 bedroom, 2 bathroom home, with a living room (daycare area), dining room, kitchen, children's dining room, detached garage with an additional dwelling unit (ADU) in the back yard.
Areas on limits to children are: living room, guest bathroom, kitchen in passing to the children's dining room , and backyard. Areas off limits to children are: all bedrooms, bathroom in one bedroom, a section of the backyard, garage and ADU. Licensee was advised to submit an updated facility sketch which indicates clearly off limit areas. All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License with Licensee. LPAs observed the required documents to be posted: Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. The following facility records were observed during the inspection: LIC 610- Facility Disaster Plan and Disaster drill log. Last documented drill date: 2/28/22. There was a current roster LIC 9040 available in the facility. There is an operable carbon monoxide detector and a smoke detector in the facility. LPAs observed a 2A10BC Fire Extinguisher in the facility.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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: 198011108
VISIT DATE: 08/02/2022
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The fire extinguisher indicated it was full but the Licensee could not provide a service tag or proof of purchase. Per the Licensee, the fire extinguisher was purchased in May 2022.
The home maintains telephone service (Land line and cell phone). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. The home is observed to be clean and orderly. There are toys and other age appropriate materials available for children. LPA also observed 2 dogs, 2 cats and a bird cage in the home. All pets were observed in off limit areas.
Sharp objects, detergents and cleaning compounds are inaccessible to children in care. Sharp objects are kept in an upper cabinet in the kitchen inaccessible to children in care. Cleaning products are kept in the cabinet under the kitchen sink. Per Licensee no children enrolled require medication. Personal medication is kept in an upper cabinet in the kitchen. The children only access the kitchen as they walk through to the children's dining room. Per Licensee, children are escorted through the kitchen. There is an air conditioning unit in the living room. Per Licensee, a portable heater is used when needed. LPA did not observe any wall heaters or fireplaces in the home. LPA observed age appropriate toys and materials in the day care room. Children have meals in the children's dining room. Children use the restroom in the hallway.
The outdoor area is separated into two sections. There is a gate separated the off limits part of the back yard. Per Licensee, vehicles are moved from the drive way and children are supervised when they play outside.
Per Licensee, there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the children's dining room with supervision. Per Licensee, there are no firearms or weapons stored in the home. LPA did not observe pools or spas, or other bodies of water.
Infant Care: Currently licensee has 1 infant enrolled. Per Licensee, infant does not nap in the facility and they are picked up mid day. Licensee was advised that napping equipment should not block entrances or exits. Infant mattresses should be firm with tightly fitted sheets. LPA discussed that each infant enrolled must have their own crib/ napping mat and bedding. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, will provide PIN 20-24-CCP. Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
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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: 198011108
VISIT DATE: 08/02/2022
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During inspection the children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
The deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D for citations.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
Exit interview conducted and report was reviewed with the Licensee Reyna Cortez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/02/2022 10:55 AM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/02/2022 at 10:19 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: CORTEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011108

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622
Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 1 staff who did not have an immunization record on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/26/2022
Plan of Correction
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Licensee will submit the immunization record for Staff 1 -measles, pertussis and flu by due date via picture or email.
Type B
Section Cited
CCR
102417(g)(1)
Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.

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. The fire extingusher in the facility did not have proof of when it was last serviced which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2022
Plan of Correction
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Licensee will provide proof of a fire extinguisher that meets standards.
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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022


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