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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214951
Report Date: 03/21/2024
Date Signed: 03/21/2024 03:24:17 PM

Document Has Been Signed on 03/21/2024 03:24 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 FCC AKA KIDZ CAREFACILITY NUMBER:
406214951
ADMINISTRATOR:MARTHA GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 221-5534
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/21/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Martha GutierrezTIME COMPLETED:
03:25 PM
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On March 21, 2024 11:15 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Required Annual Continuation inspection at the above Family Child Care Home (FCCH). LPA met with Assistants, Saveena Corona and Alyssa Gutierrez, and discussed the purpose of the inspection. Licensee, Martha Gutierrez came 10 minutes later who was out to run some errands.

Upon LPA's arrival inside the home around 11:20 AM, LPA had observed Child # 1 sitting in a high chair (feeding chair). At 11:34 AM, the LPA called Staff # 1's attention, noting that C1 should not be in the chair unless feeding, C1 was also observed crying in the high chair thus, LPA asked how long the child has been there. Staff # 1 responded C1 was just placed there and was about to eat. When asked what she was about to give C1, Staff # 1 responded "the bottle" but clarified that bottle feeding does not occur in the high chair .
LPA and Licensee toured the inside and outside of the home There were 10 children under the supervision of 3 staff. LPA observed that required forms are posted by the entrance door. FCCH utilizes the living room converted into day care area, and a room used for napping, one bathroom and completely fenced backyard, Inaccessible areas are the second floor, it was observed that the bottom of the stair case is barricaded with a baby gate, kitchen and dining, family room which are enclosed with baby gates on both ends.
Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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 FCC AKA KIDZ CARE
FACILITY NUMBER: 406214951
VISIT DATE: 03/21/2024
NARRATIVE
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 Bathroom for children’s use is free of toxins. Smoke and carbon monoxide detectors were tested and found functional. The regulation fire extinguisher was purchased was on 5/9/2023. Age-appropriate toys, books, and equipment were observed inside the home. Completely fenced backyard is equipped with age appropriate play structures and toys. LPA observed a locked trampoline in the side yard of the home. Licensee stated that this will not be used by day care children. LPA did not observe any bodies of water. Licensee stated there are no guns or ammunition in the home.

LPA reviewed the facility file and found that the Pediatric CPR and First Aid certificate expires on 5/16/2025 while Mandated Reporter Training Certificate expires on 6/28/2025 LPA reminded the licensee that AB 1207 and CPR and First Aid should be renewed every two years. Review of children's records revealed that Child #1, 2, 3, 4,7,8,9 and Child # 10's immunization records are not documented in PM 286 as required by the regulation.

Licensee stated that she does not have current liability insurance for her FCCH. LIC 282, notifying parents that FCCH does not carry liability insurance is on file. Licensee checks and logs sleeping infant every 15 minutes. The Individual Safe Sleep Plan was filled out for infants 0-12 months old. FCCH conducts and logs the fire and disaster drill every 6 months and the last drill was conducted in October 27, 2023.

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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 FCC AKA KIDZ CARE
FACILITY NUMBER: 406214951
VISIT DATE: 03/21/2024
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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 Martha Gutierrez 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, Martha Gutierrez 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/.

Continued on LIC 809 C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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 FCC AKA KIDZ CARE
FACILITY NUMBER: 406214951
VISIT DATE: 03/21/2024
NARRATIVE
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Licensee, Martha Gutierrez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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

During today's inspection, deficiencies were cited under CCR Title 22 Division 12.

A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.



Exit interview conducted and report was reviewed with the licensee, Martha Gutierrez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/21/2024 03:24 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Gigi Reyes On 03/21/2024 at 01:54 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FCC AKA KIDZ CARE
FACILITY NUMBER: 406214951

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
04/01/2024
Section Cited
CCR
101243(a)(2)

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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived...
(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by:
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Licensee agreed to submit a plan of correction letter outlining the procedures to ensure that children' are not placed in any restraining equipment such as high chairs or car seats, unless its intended for its purposes. POC must be submitted no later thatn 4/1/2024.
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During the inspection, upon LPA's arrival, LPA had observed C1 has been in the high chair sitting and started crying. This poses a potential risk to health and safety and personal rights of children 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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 03/21/2024 03:24 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Gigi Reyes On 03/21/2024 at 02:16 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FCC AKA KIDZ CARE
FACILITY NUMBER: 406214951

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
04/01/2024
Section Cited
CCR
1020418(g)(1)

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102418(g) The licensee shall document each child's immunization as required by the California Code of Regulations,
(1) This requirement includes updating each child's PM 286 (6/95)... This requirement is not met as evidenced by:
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Licensee agreed to submit a plan of correction (POC) letter outlining procedures to ensure that children's immunizations are documented. POC shall be submitted no later thatn 4/1/2024
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Review of children's file revealed that children's imunization record (Chld # 1-4, Child # ( 7-10) are not documented in PM 286 form This poses a potential risk to health and safety of children 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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


LIC809 (FAS) - (06/04)
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