334841476-4-24-2023-10-CC-AWIN-CR7Q5Q-20230424115220

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334841476
Report Date: 04/24/2023
Date Signed: 04/24/2023 11:52:30 AM

Document Has Been Signed on 04/24/2023 11:52 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	GUTIERREZ FAMILY CHILD CARE		FACILITY NUMBER:	334841476
ADMINISTRATOR:	GUTIERREZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 654-6301
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92583
CAPACITY:	14	CENSUS: 10	DATE:	04/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maria Gutierrez		TIME COMPLETED:	12:00 PM

NARRATIVE

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At 10:30AM, on April 24, 2023, Licensing Program Analyst (LPA) Alaina Wilburn arrived at the facility to conduct an annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

· Normal days and hours of operation are: Sunday through Saturday 4:00AM to 8:00PM
· Off-limit areas include: All Bedrooms, Laundry Room, Garage and Side of Backyard

· The facility is licensed to have no more than 14 children as a large FCCH and is operating within the licensed capacity and appropriate ratios.

· Appropriate supervision provided during this inspection

· A working telephone is present, and the current phone number is on file

· A fully charged fire extinguisher (2A:10BC) was observed. A smoke detector and carbon monoxide detector were present and tested by the Licensee during this inspection.

· All hazardous items are stored inaccessible to children

· Toxins are locked

· Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Clean, safe and age appropriate toy

· Current roster on file

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 334841476
	VISIT DATE: 04/24/2023

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· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted

· Documentation of fire and disaster drills on file - completed

· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Verification of control of property on file

· Children’s records are complete

· Employee’s records are complete

· Pediatric CPR and First Aid Card expires on 09/2024

· Mandated Reporter Certificate - completed on 07/02/2021

· Health & Safety Certificate - completed on 06/19/2019

· Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions.

The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 334841476
	VISIT DATE: 04/24/2023

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The Licensee was informed of their reporting requirements and was provided with the Regional Office’s
Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov

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.

Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

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

No deficiencies issued.

An exit interview was conducted, and this report was reviewed with the licensee Maria Gutierrez.

Appeal rights were discussed and provided during the exit interview.

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

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC809 (FAS) - (06/04)

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