<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015559
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:49:17 PM


Document Has Been Signed on 02/15/2023 02:49 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
198015559
ADMINISTRATOR:GUTIERREZ, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 863-1875
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 8DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Licensee Leticia Gutierrez TIME COMPLETED:
02:55 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 2/15/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensee Leticia Gutierrez and informed her of the purpose for the visit. Licensee guided LPA on a tour of the facility. There were 8 children and two additional staff present when LPA arrived. Criminal record clearance for all adults present was verified. Licensee left facility at 1:10PM to pick up a child 5. Licensee returned at 1:34PM. Assistant 1 and Assistant 2 have valid pediatric first aid cpr certification. Licensee provides care to children ages birth to 13 years old and operation days/ hours are Monday through Friday 6AM to 4:30PM.
This is a one story, two bedroom home with a living room, den/daycare room, dining room, kitchen, one bathroom inside the home, garage, backyard and an ADU (studio/1 bathroom) in the back yard.
Areas on limits to children are the living room, den/ day care room, bathroom inside the home, backyard and kitchen and dining room in passing to the day care room. Areas off limits to children are two bedrooms, garage and the entire ADU.
All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 12/20/22. Licensee had a copy of the Roster available during the inspection. There is an operable carbon monoxide detector and a smoke detector in the den/day care room. The 2A10BC Fire extinguishers indicated fully charged and were last serviced in January 2023. The home maintains telephone service (land line and cell phone). Food is provided by Licensee. Licensee was reminded that if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. The home is observed to be clean and orderly. There are toys and other age appropriate materials available for children. There is an A/C heater unit available in the daycare room.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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 7


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198015559
VISIT DATE: 02/15/2023
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
26
27
28
29
30
31
32
Page 2
LPA inspected the enclosed back yard. LPA observed age appropriate toys and materials in this area. There is a gate door near the covered patio that is kept locked during operating hours. Per Licensee, children are supervised while playing outside. Children only use the restroom in the hallway. Per Licensee children are escorted to the restroom and assisted if needed. LPA did not observe any hazards in the restroom accessible to children in care. Knives, sharp objects, detergents, cleaning compounds and medication are stored in areas inaccessible to children. Per Licensee, at the moment there are no children enrolled who require medications. Personal medications are stored in an off limits bedroom. Knives are stored in a upper cabinet in the kitchen. Cleaning solutions are stored in an upper cabinet in the hallway closet.
Per Licensee, there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room. Per Licensee, there are no firearms or weapons stored in the home. LPA did not observe pools or spas, or other bodies of water. There is one pet dog in the home. Dog is kept in the living room while children are in the daycare room.
Infant Care: Currently licensee cares for three infants. Three infants were present during the inspection. LPA observed 2 play yards in the den/day care room. Per Licensee, one of the infants naps on a napping cot. LPA observed that napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. Per licensee wet or soiled sheets are laundered in the facility. LPA discussed that each infant enrolled must have their own crib/ napping mat and bedding. One infant was observed to be napping in a play yard on their back when LPA arrived. LPA observed the play yard to be free of loose items. LPA reviewed requirements for LIC 9227 for infants under 12 months old and documentation of 15 minute sleeping log for all infants.
Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form.
Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 7 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198015559
VISIT DATE: 02/15/2023
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
26
27
28
29
30
31
32
Page 3
Licensee and assistant 1 and assistant 2 have a valid Pediatric first aid/ cpr certification issued by the Red Cross. Licensee's expires on 12/2024 , Assistant 1's expires on 10/2023 and Assistant 2's expires on 10/2024. Licensee's mandated reporter for child care providers expires on 6/7/2024, Assistant 1's mandated reporter for child care providers expires on 6/4/2024, Assistant 2's mandated reporter for child care providers expires on 6/2/2024. All staff had proof of required immunizations. During inspection the children present were observed to be treated with dignity and respect, observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
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 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm 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. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://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.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.Exit interview conducted and report was reviewed with the Licensee,Leticia Gutierrez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7