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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406212542
Report Date: 01/04/2023
Date Signed: 01/04/2023 04:55:40 PM

Document Has Been Signed on 01/04/2023 04:55 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
406212542
ADMINISTRATOR:MARIA GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 975-5570
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
01/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Maria GutierrezTIME COMPLETED:
04:00 PM
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On January 4, 2023, Licensing Program Analysts (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the Family Child Care Home (FCCH). LPA met with Maria Gutierrez, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. LPA notes four (4) children are present being cared by Licensee and Marlene Gutierrez, daughter and assistant of the Licensee.

This is a single-story home with four (4) bedrooms and two (2) bathrooms, living room, dining room, kitchen, laundry room and detached garage that has been converted into living space. The day-care services occur in the living room, dining area, bathroom, and outdoor yard when weather permits outdoor play. Meanwhile, the kitchen, four (4) bedrooms, one (1) bathroom, garage converted into studio and part of the outdoor yard is off-limits and not accessible to children in care. LPA observed the kitchen has a dutch door that is only open on the top half, making the kitchen, bedrooms and laundry room inaccessible to children in care.

LPA observed the home to be clean and orderly. There is plenty of ventilation to afford the children comfort. LPA observed medications for the family are stored in a closet in the hallway of the home. LPA observed the closet is locked and inaccessible to children in care. LPA observed sharps are stored in an elevated cabinet in the kitchen that is inaccessible to children in care. LPA observed cleaning compounds are stored in a locked closet in the hallway, on top of the refrigerator in the kitchen and in the laundry room in an elevated cabinet. LPA observed all areas are inaccessible to children in care. The restroom that is used for childcare services is clean and free of toxins. Toys, furniture, and equipment within the FCCH are age appropriate.

Required forms are predominantly posted on the wall of the daycare room. LPA observed a smoke and carbon monoxide detectors in the FCCH that were not tested at 1:35 PM and were operable during this inspection. LPA observed the home has a regulation fire extinguisher that was purchased on 9/20/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406212542
VISIT DATE: 01/04/2023
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The home maintains working telephone services.

LPA observed that part of the outdoor yard is accessible to children in care. The outdoor yard to be completely fenced. LPA observed the exit doors to be secured. The outdoor yard provides plenty of shading for the children in care. Drinking water is provided by means of individual cups. Toys, furniture, and equipment observed in the outdoor yard are age appropriate and in good conditions. No bodies of water are observed. LPA toured the garage and observed one (1) adult lives in the garage. Licensee report that sometimes that the front yard is also used for child care services when weather permits. Due to the rain, children have not had access to the any outdoor play yard. LPA and Licensee reviewed fall zone and LPA reminded Licensee to check outdoor yards prior to allowing children outdoors.

LPA reviewed Licensee and children's records. LPA reviewed children files and found them to be complete and current. In addition, all children present during today’s inspection are documented in the facility roster. LPA reviewed Licensee’s Pediatric First -aid certificate that is valid until 7/17/23 and Licensee's Mandated Reporter training certification expires 9/9/23. The last emergency drill was conducted and documented on 9/13/22. The Licensee informed LPA there are firearms and ammunition on site. Firearms and ammunition are located in bedroom of adult son. LPA observed a large safe that requires a numerical code to open. Per Licensee’s adult son, he is the only individual that has the numerical code. LPA observed ammunition is stored in a separate locked box and stored in the large safe.

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



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 violate CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406212542
VISIT DATE: 01/04/2023
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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 for 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.

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 Gutierrez in Spanish due to Spanish being the Licensee’s primary language.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC809 (FAS) - (06/04)
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