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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016431
Report Date: 10/07/2021
Date Signed: 10/07/2021 01:48:22 PM

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:
198016431
ADMINISTRATOR:GUTIERREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 639-4548
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:14CENSUS: 3DATE:
10/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria GutierrezTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPA) Elka Chavez conducted an unannounced case management inspection. Upon arrival LPA met with licensee, Maria Gutierrez whom was present with 3 children and Licensee’s Assistant, Cynthia Valencia. LPA informed Licensee the purpose of this inspection is to inform her that we have scheduled an informal meeting at the Monterey Park South West Regional.

During today’s inspection the licensee was reminded that care and supervision should only be provided by her or a fully qualified assistant. LPA asked the licensee to provide a written timeline with specific details of the incident that took place on 6/24/21. The licensee shall provide a copy of this document to the Department on the date of the scheduled informal meeting.

Exit interview was conducted with Licensee, Maria Gutierrez, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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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