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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203807077
Report Date: 11/21/2022
Date Signed: 11/21/2022 03:36:12 PM


Document Has Been Signed on 11/21/2022 03:36 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:GUTIERREZ, LAURA FAMILY CHILD CAREFACILITY NUMBER:
203807077
ADMINISTRATOR:GUTIERREZ, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 675-1678
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 8DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Laura GutierrezTIME COMPLETED:
03:45 PM
NARRATIVE
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On 11/21/2022, Licensing Program Analyst (LPA) Ka Vang and Licensing Program Manager (LPM) Luis Gavoutian conducted an unannounced Annual Required Inspection and was met by Licensee, Laura Gutierrez. Days and hours of operation are Monday through Saturday, from 3:30 AM-5:00 PM.

The home has a working telephone service and LPA confirmed the phone number is 559-675-1678 and 559-706-8880.

LPA toured the home inside and outside. Census was taken and there 8 day care children present. Current facility sketch (LIC 999A) was reviewed, and Licensee confirmed that the master bedroom, bedroom, living room, kitchen, and hallway bathroom are used for providing care and accessible to day care children. There is a laundry room next to the dining room and licensee stores her cleaning supplies and laundry detergent up high which is inaccessible to children in care. All other rooms are off-limits and made inaccessible by use of plastic doorknob cover. There is no fireplace in the facility. There are no firearms in the facility. No poisons were observed during the inspection. Medication and other hazardous items are inaccessible to children in care.

This is a 1 story home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Fire drills are conducted and documented with the date, time and how many children present, every six months.

Safe toys and play equipment were observed and are in good condition, free of sharp, loose, or pointed parts. There is one dog in the facility. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. The outdoor play area in the backyard is accessible to the children and is fenced and there are no hazards to children present.

Currently, licensee did not have infant enrolled in the facility. Licensee was made aware that there shall be one play yard for each infant in care, the play yard is kept free from all loose articles and objects while infants



(Continued on LIC809-C).
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
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 11/21/2022 03:36 PM - 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: GUTIERREZ, LAURA FAMILY CHILD CARE

FACILITY NUMBER: 203807077

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Per record reviewed, Staff #3 (S3) did not have her Criminal Record Clearance transferred to this facility. Licensing Program Manager (LPM) Luisa confirmed in the Guardian that S3 has a Criminal Record clearance in another day care facility.
POC Due Date: 12/05/2022
Plan of Correction
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During today's inspection, Licensing Program Analyst (LPA) Ka & LPM Luisa observed S3 completed the required forms for the Criminal Record Clearance to be transfer to this facility. LPA take the forms to Community Care Licensing-Fresno Office for processing to have the Criminal Record Clearane transfer. Licensee was advise that S3 can not be present in the facility until her Criminal Record Clearance is transfer to this facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GUTIERREZ, LAURA FAMILY CHILD CARE
FACILITY NUMBER: 203807077
VISIT DATE: 11/21/2022
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are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. LPA advised licensee that she is required to document any sign of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing on a sleeping log. Infants can be visually observed through an open door if sleeping in a separate room.

LPA 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 resources. 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.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter training was completed on 01/22/2021. Licensee’s pediatric CPR/First Aid expires on 05/22/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

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. Per record reviewed, Staff #3 (S3) did not have her Criminal Record Clearance transfer to this facility. Record reviewed and S3 has a criminal record clearance with another facility. Due to the health and safety of the children in care, a citation of Type B was cited during today’s inspection.

(Continued on LIC809-C).

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GUTIERREZ, LAURA FAMILY CHILD CARE
FACILITY NUMBER: 203807077
VISIT DATE: 11/21/2022
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed and IMS not provided. 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 Centers and the ADA, available at: https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed 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.



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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D).



Licensee was provided a copy of appeal rights.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee Laura Gutierrez.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
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