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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500227
Report Date: 06/08/2020
Date Signed: 06/08/2020 11:27:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:GUTIERREZ, BRENDA NATHALIFACILITY NUMBER:
344500227
ADMINISTRATOR:GUTIERREZ, BRENDA NATHALIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 519-6016
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:14CENSUS: 0DATE:
06/08/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Brenda Nathali GutierrezTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Fabiola Diaz conducted a case management tele-inspection via Facetime with applicant, Brenda Nathali Gutierrez, due to COVID-19 in lieu of an on-site visit. The purpose of today's tele-inspection was to conduct a change of location tele-inspection for a large family home day-care. All individuals subject to criminal background review have obtained a criminal record clearance. The applicant’s children were present during the tele-inspection.

A health and safety tele-inspection was conducted inside and out through Facetime. The two story home has an unfenced front yard, 4 bedrooms, 3 bathrooms, a bonus room, living room, a dining room, family room, kitchen, nook, garage, laundry room, and fenced backyard. The off-limit areas in the home are entire upstairs, laundry room, garage, downstairs bedroom, and gated side backyard. Applicant stated that off-limit areas will remain inaccessible to children in care at all times. The home has a properly barricaded fireplace. Safety latches are in use on some kitchen cabinets and drawers. The applicant understands that she must ensure the safety latches are not broken. LPA advised the applicant that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors and a 2A10BC fire extinguisher were observed in the home. Applicant stated there are no weapons in the home. There are no pools, spas, or other bodies of water at the home. Applicant stated she is currently working on getting liability insurance for a childcare facility, but she will have the parents sign the Affidavit of the Liability Insurance (LIC 282) in the mean time. Current pediatric CPR and first aid training was verified and expires 5/31/2022. Applicant completed the CA AB1207 Mandated Reporter training on 4/26/2020. Applicant completed the Preventative Health and Safety Training on 5/30/2020. The Fire Marshall has inspected and approved the fire clearance for the large family child care home effective 5/18/2020.

Page 1. Report Continues on LIC 809-C...
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GUTIERREZ, BRENDA NATHALI
FACILITY NUMBER: 344500227
VISIT DATE: 06/08/2020
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Applicant was encouraged to maintain supervision at all times. Immediate Civil Penalty regulation deficiencies were reviewed. LPA discussed requirements for staff, adult assistants, and adults living in the home. LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against, Pertussis, Measles and Influenza. LPA observed proof of applicant's immunization in the facility file.

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



This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided and discussed the Safe Sleep in Child Care brochure and the Effects of Lead Brochure. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov

Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months. Applicant understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

Page 2. Report Continues on LIC 809-C...
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GUTIERREZ, BRENDA NATHALI
FACILITY NUMBER: 344500227
VISIT DATE: 06/08/2020
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Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area. Applicant understands that children’s records are to be maintained according to Title 22 regulations, and be accessible to licensing for up to three years.

Effective today, 06/08/2020, LPA is granting a large family child care license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.

An exit interview was conducted. A copy of this report was e-mailed to the applicant to keep on file at the facility. A “read receipt” and/or an e-mail from applicant stating applicant has read this report is in lieu of a signature due to COVID-19.

Page 3.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3