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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214951
Report Date: 08/14/2024
Date Signed: 08/16/2024 02:24:26 PM

Document Has Been Signed on 08/16/2024 02:24 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/
DIRECTOR:		MARTHA GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 221-5534
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/14/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:16 AM
MET WITH:Martha GutierrezTIME VISIT/
INSPECTION COMPLETED:
05:35 PM
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This is a required inspection per CDSS no. 6421215101-B Decision and Order.

On 8/14/2024 at 9:16 AM, Licensing Program Analysts (LPAs) Gigi Reyes and Matthew Sapien conducted an unannounced required inspection at the above Family Child Care Home (FCCH) . LPAs met with Licensee, Martha Gutierrez and discussed the purpose of the inspection. FCCH operates Monday to Friday, from 8:00 AM to 4:00 PM. Licensee cares for children 0-13 years if age.

LPAs and Licensee toured the inside and outside of the home. LPAs observed 9 children present under the supervision of licensee and assistant. FCCH day care areas are the open space by the main entrance door and napping room across the hallway. LPAs did not observe a copy of CDSS 6421215101-B Decision and Order posted in the home. Per Decision and Order (DO) CDSS 6421215101-B under the Probation Terms and Conditions, " the proposed Decision and the Department’s Decision and Order shall be posted in a conspicuous place at each respondent’s facility for the duration of the probationary period. "

Smoke and carbon monoxide detectors were tested and found functional; the regulation fire extinguisher was serviced on 5/15/2024. Age-appropriate toys, book, cots, and playpen and equipment were observed in the home. Backyard is enclosed with wooden fence.
Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 08/14/2024
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LPA reviewed the facility file and found that the Pediatric CPR and First Aid certificate is current with expiration date of 5/16/2025 while Mandated Reporter Training was completed on 6/28/2023 (6/28/2025) Children’s records were reviewed, Licensee and assistant check and document the napping infant every 15 minutes. The Individual Safe Sleep Plan was filled out for infants 0-12 months old. Childcare facility roster is not updated, Child #1 – Child # 5 are not listed. Licensee stated that FCCH conducts and documents fire and disaster drill every 6 months, last drill was conducted on 4/3/2024 Licensee stated there are no guns or ammunition in the home. Residential Lease Agreement was reviewed, Licensee and spouse’s names, Michael and Martha Gutierrez are on the lease agreement as tenants. Licensee has landlord consent (LIC 9149) on file.

During the inspection LPAs reminded Licensee that the plan of corrections for the deficiencies cited on 3/21/2024 was not received. Licensee failed to submit the required POC within the time frame of ten days from the citation date. When addressed about this, licensee stated that she was not aware that a type B citation required a Plan of Correction. LPAs mentioned that failure to correct could result to an assessment of civil penalty of $100 per day as stated on the deficiency page LIC 809D. Licensee responded that she was not even aware that she had any deficiencies. Today a civil penalty of $27,000 was assessed for failure to correct 2 deficiencies for a period of 135 days. LIC 421FC – Civil Penalty for Failure to Correct was provided to licensee,
Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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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: 08/14/2024
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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, with 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, 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.

Continued on LIC 809C

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

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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: 08/14/2024
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The FCCH is not providing Incidental Medical Services (IMS). 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, 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 title 22 division 12 and California Code of Regulations and Health and Safety Code.

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: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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Document Has Been Signed on 08/16/2024 02:24 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Gigi Reyes On 08/14/2024 at 04:46 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: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Under Appeal
Type B
Section Cited
CCR
102417(g)(8)
Each Family Child Care Home shall have a current roster of children as specified in Health and Safety Code Section 1596.841

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply wiht the section cited above, in 5 out of 9 children present, 5 children , Child # 1 to Child # 5 were not listed in the facility roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/26/2024
Plan of Correction
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During the inspection, licensee added the names of Child # 1 to Child # 5 in the child care facility roster.
Under Appeal
Type B
Section Cited
HSC
1596.8595
Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services
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 decision and Order was not posted at the FCCH.which poses/posed a potential health, safety or personal rights risk to persons in care.
Per Decision and Order (DO) CDSS 6421215101-B under the Probation Terms and Conditions, the proposed Decision and the Department’s Decision and Order shall be posted in a conspicuous place at each respondent’s facility for the duration of the probationary period
POC Due Date: 08/26/2024
Plan of Correction
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Licensee agreed to submit a written plan of correction outlining measures to prevent the recurrence of the similar incident no later than 8/26/2024
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: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


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