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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216922
Report Date: 04/23/2024
Date Signed: 04/23/2024 12:48:14 PM

Document Has Been Signed on 04/23/2024 12:48 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
406216922
ADMINISTRATOR/
DIRECTOR:		GUTIERREZ, MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
8058353741
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 0DATE:
04/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:(Licensee) Michael GutierrezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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This is a change of location, previous facility number 406215801.

On 04/23/2024, Licensing Program Analysts (LPAs) Joaquin Mendez and Martina Jimenez, conducted an announced, Pre-licensing inspection for a large Family Child Care Home (FCCH) license. LPAs met with Michael R Gutierrez, applicant. The purpose of the inspection was discussed and together LPAs and applicant toured the inside and outside of the home. There were no children present at the time of the inspection.

The applicant is requesting a large family childcare license. The home is a two-story home, which consists of four (4) bedrooms, three (3) bathrooms, living room, family room, kitchen, dining area, laundry room, garage and completely fenced back yard. LPAs notes that the day care services will occur in the front living room, bathroom downstairs, and completely fenced backyard outdoor play area.

The off-limits areas consist of four (4) bedrooms, two (2) upstairs bathrooms, kitchen, family room, dining room, laundry room and garage. LPAs observed a safety gate preventing children in care access to upstairs and a chain link lock preventing access to garage making the four (4) bedrooms, and garage inaccessible to day-care children. LPAs observed a retractable mesh fence from the kitchen wall to the dining area wall making the family room, dining area and kitchen inaccessible to children in care.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 04/23/2024
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Per Applicant, the operating hours will be Monday through Friday from 8:00 a.m. to 5:00 p.m. Applicant states he wants to care for children from 0 to 11 years of age.

LPAs observed the FCCH is fully equipped to meet the needs of children in care. LPAs observed that the FCCH is clean and orderly. In addition, there is plenty of ventilation for the children in care. LPAs did not observe any toxins nor hazards items accessible to children in care.

LPAs observed that knives and medication are stored in an elevated cabinet in the kitchen and an upstairs bedroom inaccessible at the time of the inspection. Cleaning compounds were observed in the washroom cabinets above the washer and dryer that was secured with a chain link lock making the cleaning compounds inaccessible to children in care. The bathroom to be used for children in care was observed to be clean and free of toxins. LPAs observed child size furniture and material for activities throughout the home in areas that will be accessible to children in care.

LPAs and applicant together toured the outdoor play area. There were no bodies of water observed at the time of the inspection. Applicant stated there are no bodies of water at the home. LPAs advised the applicant children must never be unsupervised while the children are at the play area.

LPAs observed the exits to be secured. LPAs observed there is shading to afford the children in care. In addition, filtered water will be accessible by means of water jug with individual water cups. The play area has age-appropriate toys and day-care equipment. LPAs and applicant discussed active supervision when children are in the outdoor yard.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 04/23/2024
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 No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.


LPAs observed two (2) regulation 2A10BC fire extinguishers that were serviced on 5/09/2023. Licensee is reminded to service or purchase the fire extinguisher yearly. LPAs observed applicant test a combination smoke and carbon monoxide detectors in the home at 10:34 AM and were functioning at the time of the inspection. Applicant stated that there are no weapons or ammunition in the home. First Aid and emergency kits are available in the kitchen.

Applicant is current with immunization required per SB 792. Applicant Pediatric First Aid/CPR certificate is valid until 5/16/2025. Applicant’s Mandated Reporter Training certificate is valid until 6/28/2025.

The applicant provided proof of control of property. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

All adults living and working in the home shall be made of aware of the Department inspection rights authority.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 04/23/2024
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There are five (5) adults living in the home, which all adults residing in the home have been fingerprint cleared. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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) or (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.

LPA reviewed with applicant, the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant, and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource.


SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 04/23/2024
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LPA also informed applicant, 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.

On this date, 04/23/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 04/23/2024
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https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

The Paso Robles Fire Department granted a fire clearance following an inspection completed at the FCCH on 4/01/2024. The home meets Title 22 of CCR for a Large Family Child Care license effective 4/23/2024. The probationary license is approved for 14 children per CDSS No. 642125101B effective today 4-23-2024 until 4-28-2026, after which, the regular license will be issued. A notice of site visit was given to applicant, 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, Michael Gutierrez.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
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