197408665-4-30-2019-30-CC-DMIA-BBQU53-20190430151605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408665
Report Date: 04/30/2019
Date Signed: 04/30/2019 03:16:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	GUTIERREZ FAMILY CHILD CARE		FACILITY NUMBER:	197408665
ADMINISTRATOR:	GUTIERREZ, HORTENCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	3103019787
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY:	14	CENSUS: 11	DATE:	04/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Hortencia Gutierrez, Licensee and Licensse's Assistant		TIME COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/30/2019 at 12:45pm Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced annual/random inspection today. LPA met with Hortencia Gutierrez, licensee, who guided analyst on a tour of the facility. Licensee stated that her operation hours is Monday to Friday from 7:45am to 5:15pm. Licensee provided an original form# LIC279 Application form (updated the new operation hours and dates) to LPA. and a copy of the form# LIC279B Current children in your home. LPA observed 11 children (licensee, licensee’s assistant) adults present at the time of the inspection. LPA verified that all adults present in the home have obtained fingerprint clearances and are associated to the facility. All areas identified on the facility sketch were inspected. This facility is a single-story dwelling with 4 bedrooms, 3 bathrooms, one living room combine with a dining room, one family room combine with kitchen, and a detached garage. Main care is provided in the playroom. Children use the bathroom located in the family room. Children have access to the family room, kitchen, bedroom #4, and backyard. Off limit areas include the home's 3 bedrooms (#1, #2 and #3), 1 bathroom (master bedroom) and the garage, living room combine with a dining room area. The home was inspected inside and out for safety, comfort, cleanliness, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Facility annual fees are current. Facility roster complete and maintained current. Licensee has one pet dog. Per licensee the dog are in off limit by the left side of the house. Children play in the backyard. LPA inspected the backyard area which is used for outdoor activities. The yard is properly fenced. LPA observed a barbecue island (covered) on the right side of the yard, which is off-limits to children. There is a grass and concrete area for active play. There are no swings or slides. LPA did not observe any debris or hazards that would pose a risk to children in care. Toys appeared to be in good condition. LPA inspected the garage area that is used for storage. Per licensee the garage is used for storage only.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
	VISIT DATE: 04/30/2019

NARRATIVE

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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

Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Fire and safety drills must be performed every six months and documented for review by the Department.

Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

The following were also discussed with licensee:
Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.
New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division
300 N. Continental Blvd. Suite, 290A
El Segundo, CA 90245

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
	VISIT DATE: 04/30/2019

NARRATIVE

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All areas used by children were inspected for safety, comfort, cleanliness, ventilation, and heating (central). LPA observed a working smoke detector, carbon monoxide detector and 2A10BC Fire Extinguisher (serviced on September 2018). Medications are stored away from children’s reach. Per the licensee, there are no firearms on the premises. LPA observed a well-stocked first aid kit.
On 4/30/2019 at 1:26 pm, review of records was conducted. LPA observed the file were completed.

LPA observed that licensee has current Pediatric First Aid and Adult, Child and Infant CPR (which expires on 04/2021. LPA observed that all necessary postings (i.e. Notification of Parents’ rights, Emergency Disaster Plan, Facility License) were posted on a board located at the playroom area.
LPA discussed with licensee that walkers, exersaucers/walkers without wheels, jumpers & bouncers are not allowed in day care facilities. LPA discussed capacity limitations, new car seat law, personal rights, Notification of Parent's Rights revised 12/06, inspection authority & agency's consultative role. Smoking is prohibited on the premises when children are present. The LPA also discussed earthquake safety and necessity of drills every 6 months.

The Licensee was also informed that all adults living in or having access to day care children in the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of $100 /day per uncleared adult will be assessed.

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov.

Licensee states at this time is not providing Incidental Medical Services (IMS)

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

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
	VISIT DATE: 04/30/2019

NARRATIVE

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Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com.

During this inspection, LPA also provided the following documents about SIDS. 1) A Child Care Provider’s Guide to Safe Sleep by the American Academy of Pediatrics, 2) 1-844-LET-US-NO, 3) Never ever shake a Baby by California Department of Social Services, 4) California School Immunization Record form CDPH286, 5) California Law – Car Seat by California Department of Public Health, LIC311D Forms/Records to Keep in For Family Child Care.

Per licensee requested, LPA provided copy of the Title22 102418. Immunization.

The facility was found to be in substantial compliance per Title 22 Regulations and Health Safety Code. A copy of report, a Notice of Site Visit were issued and explained to the Licensee.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019

LIC809 (FAS) - (06/04)

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