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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414289
Report Date: 09/23/2025
Date Signed: 09/23/2025 10:24:49 AM

Document Has Been Signed on 09/23/2025 10:24 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:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
197414289
ADMINISTRATOR/
DIRECTOR:		GUTIERREZ, ERICKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 953-5522
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
09/23/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee GUTIERREZ, ERICKATIME VISIT/
INSPECTION COMPLETED:
10:38 AM
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On 9/23/25 Licensing Program Analysts (LPA) Tyler Reyes conducted an unannounced Annual/Random inspection. LPA met with Licensee Gutierrez, Ericka provided an Entrance Checklist-Family Child Care Homes LIC 126. LPA conducted a tour of the facility led by Licensee. LPA observed (5) children in care. Per Licensee hours of operation Monday-Sunday from 6am- 6am. LPA discussed with Licensee that “Overnight Care” means care being provided to children anytime between the hours of 6pm and 6am. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered care.LPA discussed and provided copies of Capacity Regulations for Family Child Care Home License, Personnel Report LIC 500, and Child Care Facility Roster LIC 9040.

During the inspection, the following individuals were present in the home: Licensee and Staff 1 (S1). All adults present in the home have obtained a criminal record clearance or exemption. LPA informed that any individual that has direct contact with the children and resides in the home is required to have a criminal record clearance or exemption.

Facility Postings: LPA observed the required postings at the entrance: Facility License PUB 394 Notification of Parents’ Rights, LIC 9148 Earthquake Preparedness, and LIC 610A Emergency Disaster Plan LPA discussed the documents to be posted in a prominent, publicly accessible area at facility.

Emergency Disaster Drill: Fire and Earthquake Drill 8/11/25

Pediatric CPR/First Aid in Pediatrics Certification: Licensee American Heart Issued 12/28/24 and Renew 12/2026 and S1 American Heart Issued 12/28/24 and Renew 12/2026

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/23/2025 10:24 AM - It Cannot Be Edited


Created By: Tyler Reyes On 09/23/2025 at 10:04 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: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

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 Staff 1 (S1) was missing proof of immunization of measles and pertussis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
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Licnesee will ensure all employees have proof of immunization. Licnesee will provide proof of immunization of measles and pertussis for S1. Plan of correction will be cleared by visit.
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.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2025


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: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414289
VISIT DATE: 09/23/2025
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Facility Sketch: The facility is a single-story home consist of a Front yard, dinning room, living room, kitchen, (1) restroom, (2) bedrooms, enclosed backyard, and detached garage.

On Limit: Front yard, dinning room, living room, kitchen, (1) restroom, (1) bedroom, and backyard.

Off Limit: (1) bedroom and garage.

. Licensee was informed that any future changes to the facility sketch must be updated and submitted to the department.

Infants: LPA observed (0) infants in care. LPA discussed infant safe sleep with Licensee. Facility should supervise infants while they are sleeping adhering to physical checks every (15-minute) and ensuring infants are sleeping on their back. Documentation of these checks shall be maintained in the infant’s file and made available for Department review. Documentation shall include the date, infant’s name, and the time of each (15-minute) check. The infant’s authorized representative and emergency contact shall be notified if any signs of distress or labored breathing are observed. Cribs or play yards shall be free from all loose articles and objects. The crib or play yard is required to be equipped with a fitted sheet and fitted mattress. LPA informed Licensee pacifiers shall be allowed in crib or play yard if the following: There shall not be anything attached to the pacifier and pacifier shall be specific to the infant. An individual Sleep Plan LIC 9227 shall be completed for each infant up to12 months of age. LPA provided the Licensee with copies of the Infant Safe Sleep information from California -DSS-Manual -CCL.

Items not permitted: LPA provided the Licensee with a picture listing some of the items not permitted in a family childcare home, which include a bouncer, a jumper, and a walker. These items are not allowed to be on the premises of the facility.

Transportation: Per licensee transportation is provided for children in care. A valid California Driver License for S1 was observed with an expiration date of 9/9/2026

Meals: Per Licensee children will have meals in living room. Licensee was advised to ensure all food brought from home is properly labeled and stored. Per Licensee no children have reported food allergies.

Medication: Per Licensee the facility will provide incidental medical services. If required, medication will be inaccessible to children by centrally storing and locking. Medications will be administered in accordance with PIN 22-02-CCP, which outlines requirements for proper storage, documentation, and staff training.

The following on-limit areas that will be used by children were inspected for safety, comfort, and cleanliness. Heating and cooling is provided by portable air conditioners. LPA observed age-appropriate toys and learning

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414289
VISIT DATE: 09/23/2025
NARRATIVE
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materials. Telephone service is provided via cell phone. LPA reminded the license to ensure that unused electrical outlets always remain covered. LPA observed a fire extinguisher in the dinning room with a service tag of 5/5/25. Family Child Care Homes are required to maintain a new or serviced fully charged fire extinguisher which is at least a 2A:10BC annually. LPA observed a wall heater positioned in the living room and hallway. LPA observed a document from Gas Company stating the wall heater is non-operational 2/22/07. LPA observed an operable smoke and carbon monoxide detector. LPA reminded Licensee to ensure all sharps are stored in manner that both inaccessible and age-appropriate for children in care. Per Licensee there are no firearms on the premises. If firearms are present, LPA verified per Title 22 regulations that they are locked, with ammunition stored separately.

Poisons/Cleaning Products: Poisons and cleaning products were observed to be key locked in cabinet. LPA observed no personal hygiene products accessible in on-limit restroom.

Outdoor: Front yard and backyard are used for outdoor play. Per Licensee children will be supervised during outdoor play. Per Licensee they have (1) dog. Per Licensee backyard is cleared of animal feces prior to outdoor play. LPA discussed and provided copies of PIN 25-06 Extreme Heat Prevention. No pool, spas or other bodies of water.

Staff Files: LPA reviewed Licensee and S1 file for the following documentation records: LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirements to Report Child Abuse, Proof of Immunizations, and Mandated Reporting Training Certificate. (1) of (2) staff had required documentation. S1 was missing proof of immunization for measles and pertussis which poses a potential health and safety risk.

Children Files: LPA reviewed child 1 (C1-C2) file for the following documentation: LIC 282 Affidavit Regarding Liability Insurance, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 9224 Acknowledgment of Receipt of Licensing Reports it was not applicable. (2) of (2) children had required documentation.

LPA discussed reporting requirements and the staff’s responsibilities as a mandated reporter, including the obligation to report to Community Care Licensing and emergency personnel when necessary.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414289
VISIT DATE: 09/23/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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.

LPA 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-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

During the exit interview, the LICENSEE Ericka, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and Appeal Rights provided with Licensee Ericka. Please see attached LIC 809-D for citations.

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC809 (FAS) - (06/04)
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