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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216922
Report Date: 08/14/2024
Date Signed: 08/14/2024 10:48:51 AM

Document Has Been Signed on 08/14/2024 10:48 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
406216922
ADMINISTRATOR/
DIRECTOR:		GUTIERREZ, MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 835-3741
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Michael GutierrezTIME VISIT/
INSPECTION COMPLETED:
09:42 AM
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On 8/14/14, at 9:15 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Shane Loftus conducted an unannounced Annual Random/Comprehensive inspection of the abovementioned Family Child Care Home (FCCH). LPAs met with Michael Gutierrez, Licensee of the FCCH and explained the nature and purpose of the inspection. It is noted Decision and Order CDSS No .6421121502, dated 1/30/23, notes Michael Gutierrez's license to operate a FCCH is revoked. The revocation of the license is stayed, for a period of three years during which time Michael Gutierrez is be granted a probationary license subject to the limitations and specified conditions. The LPAs, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH is a four bedroom, three bathroom, two story dwelling. The FCCH’s living room, first floor bathroom and backyard are used for children care services, while the remainder of the FCCH is excluded from care. LPAs observed a child safety gate at the base of the stairwell serving as a barricade to the FCCH’s upper story. A retractable mesh fence is also observed at the entry of the FCCH’s kitchen. LPAs note seven children are on site, along with an Assistant (cleared and associated) providing care and supervision.

Required forms are predominantly posted on the wall near the entry of the FCCH. The FCCH’s living room has a fireplace which is screened by glass. The FCCH's bathroom used for child care services is observed to be clean and free of toxins. LPAs observed combination smoke and carbon monoxide detectors throughout the FCCH. A combination detector in the family room was tested at 9:28 AM and found to be operable. The FCCH has a regulation fire extinguisher on site which was service on 5/13/24. LPAs reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services.

The FCCH was observed to be clean and orderly. Medication in the home is a bedroom in the upper story of the home which is excluded from care. Cleaning compounds are stored in a secured laundry room which is inaccessible to children in care. Sharps are observed in an elevated location in the kitchen cabinets which is inaccessible to children in care. . Toys, furniture and equipment in the FCCH are age appropriate.


(CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
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.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 406216922
VISIT DATE: 08/14/2024
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As noted, outdoor child care service activities occur in the backyard. The backyard is enclosed by wooden fencing, while the footing in the area is varied. LPAs observed the backyard fence’s entry/exit gates to be secure. Toys and play equipment observed in backyard are age appropriate and in satisfactory condition. Licensee is reminded to replace toys and play equipment which start to degrade or are not in good repair. LPAs informed Licensee to ensure children in care are directly supervised when engaged in outdoor activities. LPAs observed no bodies of water on site.

LPAs reviewed children's records. The records are current, complete and possessed emergency contact information and immunization records, among other required licensing documents and forms. A review of the FCCH's fire drill log reveals fire drills are current with the last fire drill on site occurred on 6/16/24. The Licensee's records are also current and complete with Pediatric CPR and First Aid certifications (EMSA approved) expiring on 5/16/25. The Licensee's Mandated Reporter training certification expires on 6/28/25. Licensee is reminded to renew certifications and training prior to expirations. The Licensee informed LPAs no firearms or ammunition are stored on site.

The Licensee does not provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02CCP. 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.



LPAs 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. LPAs 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.

Licensee 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,
(CONT. 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
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)
Page: 2 of 3
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: 406216922
VISIT DATE: 08/14/2024
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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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 8/2/24.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Michael Gutierrez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
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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