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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320129
Report Date: 12/16/2022
Date Signed: 12/16/2022 02:58:02 PM

Document Has Been Signed on 12/16/2022 02:58 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CASA DE ESTRELLAFACILITY NUMBER:
198320129
ADMINISTRATOR:BUSTOS, GLENDAFACILITY TYPE:
740
ADDRESS:22313 MADISON STREETTELEPHONE:
3105040648
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 5DATE:
12/16/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Melanie Tallada - Co-AdministratorTIME COMPLETED:
03:30 PM
NARRATIVE
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On 12/16/2022, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced case management – deficiency visit. LPA Leon conducted a risk assessment with Co-Administrator Melanie Tallada (CA1) who confirmed the facility is free of Covid-19 infection. LPA met with CA1 and explained the purpose of today’s visit.

On 12/12/2022, LPA Lourdes Montoya observed RFCE Administrator Certificate # 6003752740 for Glenda L. Bustos with expiration date of 6/19/2021. Administrator told LPA Montoya that she submitted the renewal and is still waiting for the certificate. On 12/16/2022, LPA Leon also verified the “Active Certificates List” and “Pending Applications List” on the State of California website and LPA did not find Glenda Bustos’ name on either list. This indicates that Glenda Bustos has no active or pending certificate and therefore it has expired.

During today’s visit, LPA Leon observed an expired RFCE Administrator Certificate for Glenda L. Bustos, with the date as 6/19/2021. The facility does not have a designee based on review of facility’s file with CCLD.

One deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22.



Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights were provided to Melanie Tallada.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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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Document is an Amendment of Original Document on 02/23/2023 11:16 AM


Created By: Mario Leon On 12/16/2022 at 12:36 PM
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CASA DE ESTRELLA
FACILITY NUMBER: 198320129

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2022
Section Cited
CCR
87405(a)

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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. ...The administrator shall ... shall be on the premises a sufficient number of hours to permit adequate attention...section.
This requirement is not met as evidenced by:
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The administrator shall submit a proof of submission of administrative renewal packet to CCLD, via email, to mario.leon@dss.ca.gov by the POC due date.
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Based on observation, interview and record review, the Administrator Certificate has expired on 6/19/2021. The facility does not have a designee based on review of facility’s file with CCLD. This poses potential health, safety or personal rights risk to persons in care.
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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:Ulysses Coronel
LICENSING EVALUATOR NAME:Mario Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2022


LIC809 (FAS) - (06/04)
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