197408665-1-24-2025-30-CC-RRID-DD8MSW-20250124085237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408665
Report Date: 01/22/2025
Date Signed: 01/24/2025 08:53:08 AM

Document Has Been Signed on 01/24/2025 08:53 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	GUTIERREZ FAMILY CHILD CARE		FACILITY NUMBER:	197408665
ADMINISTRATOR/ DIRECTOR:	GUTIERREZ, HORTENCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 301-9787
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	01/22/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Hortencia Gutierrez		TIME VISIT/ INSPECTION COMPLETED:	02:35 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 1/22/2025 Licensing Program Analysts (LPA), Ranita Richmond and Brittany Lovest conducted an unannounced 3 yr. Required Inspection and was met by Licensee Hortencia Gutierrez. LPA observed 6 children being cared for and supervised by licensee, co licensee, and 1 fingerprint cleared assistant. Additionally, one adult resident was present in the home during inspection. All adults present have a criminal record clearance. Days and hours of operation are Monday through Friday 8:00am to 5:00pm. Licensee provides meals, snacks, and water. LPAs toured the home inside and outside for a Health and Safety inspection. The home is neat and clean with heating and ventilation for safety and comfort. LPA Richmond confirmed that the home consists of living room, dining room, family room, kitchen, 4 bedrooms, 21/2 bathrooms, enclosed patio, fenced backyard, detached garage, additional room attached to the garage, that includes a kitchenette, and bathroom. The ON LIMIT AREAS are as follows: enclosed patio (main daycare area/napping area), bathroom #3 (half bath), bedroom #4, kitchen (walk through only), family room (isolation area), and fenced back yard. The OFF-LIMIT AREAS are as follows: bedrooms #1, #2, #3, detached garage, bathrooms #1, #2, and additional room. page 1 of 5

Claudia Escobedo	TELEPHONE: (424) 301-3044
Ranita Richmond	TELEPHONE: (424) 301-3065
	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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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Document Has Been Signed on 01/24/2025 08:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Infants up to 12 month of age who are sleeping in a position other than on their back. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 of 2. Licensee did not physically check on sleeping infant which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/05/2025
	Plan of Correction
1 2 3 4	Licensee will physically check on sleeping infants and place infants 12 months and under on their back to sleep.

Section Cited

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 of 2. Co licensee TB test not on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/05/2025
	Plan of Correction
1 2 3 4	Licensee will provide copy of TB test for file.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Claudia Escobedo	TELEPHONE: (424) 301-3044
Ranita Richmond	TELEPHONE: (424) 301-3065
	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/24/2025 08:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1of 1. Section D of LIC 9227 not completed by licensee which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/05/2025
	Plan of Correction
1 2 3 4	Licensee will lay children 24 months and under to sleep on their back. Licensee will complete Section D of LIC 9227 and 24 hours after completion if child adjusts sleep position, the child is able to remain in adjusted position.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Claudia Escobedo	TELEPHONE: (424) 301-3044
Ranita Richmond	TELEPHONE: (424) 301-3065
	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
	VISIT DATE: 01/22/2025

NARRATIVE

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Parents and children enter from the side of the home close to the alley, to access the fenced backyard to get to the enclosed patio on the left. On the right side of the fenced backyard is the detached garage and additional room. Upon entering the enclosed patio, there is a door to the right that leads to the family room. Inside the family room to the left is the half bath. Through the family room to the left is the kitchen. In the kitchen making an immediate right is a hallway to the right that leads to bedrooms #2, #3, #4, and bathroom number #2. Through the family room to the far right is a door to the right that leads to the dining room, living room, front entrance to the house. At the front entrance of the home to the right is bedroom #1. Inside bedroom #1 is bathroom #1. Between the dining room and living room is a doorway that accesses the hallway to bedrooms #2, #3, #4, and bath #2.

Licensee is aware that the children must nap and have meals in the home.

LPA Richmond observed a fully charged 2A:10B:C Fire Extinguisher in the enclosed patio and working smoke detectors and carbon monoxide detectors throughout the home.

There are no firearms or ammunition on the premises.

There are no pools, ponds or other bodies of water on the premises.

Licensee has a 19-month old white Maltese dog (Summer). Per licensee the plan for Summer is to stay in off limits room with adult resident until approximately 9:30am daily. At 9:30am until close of business at 5:00pm Summer is housed on side of the house behind a closed gate. Licensee provided LPA with written, signed plan of action for Summer to be filed.

LPA Richmond observed age-appropriate toys, books and furnishings. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts.

During walk through LPA observed a screened fireplace in the living room. LPA observed poisons, detergents, cleaning compounds, and medication were made inaccessible to children in care by locked cabinets and off limits areas.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita Richmond	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC809 (FAS) - (06/04)

Page: 4 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
	VISIT DATE: 01/22/2025

NARRATIVE

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LPA reviewed 6 children’s files and observed them to be in compliance as they contained current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and authorization for medical treatment, signed Parent’s Rights. During file review LPA observed C4, LIC 9227 section D has not been completed. C4 was observed by LPAs during walk through sleeping on stomach in play pen. Citation issued. See LIC 809D. LPA reviewed infant sleep log. Infant sleep log indicates that C4 was placed on stomach to sleep. Citation issued. See LIC 809D.

LPA Richmond observed the licensees and assistants has a current 1^st aid/cpr. LPA observed that licensee and assistant have current mandated reporter training. Co Licensee is currently missing TB test information on file. Citation issued. See LIC 809D.

LPA provided applicant with 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. LPA Lovest gave applicant a packet of all required forms, and posters and reviewed following forms:

CHILDREN'S RECORDS REQUIREMENTS:

· LIC 700 Identification and Emergency Information

· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· LIC 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights
· Immunization Record

FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita Richmond	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC809 (FAS) - (06/04)

Page: 5 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
	VISIT DATE: 01/22/2025

NARRATIVE

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FORMS TO BE POSTED
· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster
In addition, LPA Richmond informed applicant of the following:
· There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· Saucer chairs, bouncers, walkers, or any similar items are prohibited.
· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

LPA discussed the safe sleep regulations with licensee 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. LPA 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.

Incidental Medical Services (IMS) are not currently being provided.

Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA Richmond reminded Licensee of the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita Richmond	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC809 (FAS) - (06/04)

Page: 6 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 197408665
	VISIT DATE: 01/22/2025

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee 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&R) throughout California.

Three type B Citations issued during this visit per Title 22 Regulations and Health and Safety Codes. See LIC 809D.

An exit interview was conducted, a copy of this report and appeal rights was read and provided to Licensee Hortencia Gutierrez.
Notice of Site Visit was provided and required to be posted for 30 days.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita Richmond	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC809 (FAS) - (06/04)

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