406214951-11-21-2019-17-CC-GRES-BJ5LT9-20191121080154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406214951
Report Date: 11/20/2019
Date Signed: 11/21/2019 08:02:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GUTIERREZ FCC AKA KIDZ CARE		FACILITY NUMBER:	406214951
ADMINISTRATOR:	MARTHA GUTIERREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 221-5534
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	14	CENSUS: 12	DATE:	11/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Martha Gutierrez		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Annual/Random Inspection and met with Licensee and Assistant. There were 12 children present . This is a two storey home with four bedrooms and 4 baths. The second level, family room, kitchen and garage are not accessible to children. There are 2 rooms designated for day care children. The backyard is completely fenced with age appropriate play structure. Licensee stated backyard is not being used by day care children due to cold weather. Licensee stated there are no guns nor ammunition in the home. Fire Extinguisher was serviced on 11/20/19. Carbon monoxide and smoke alarm detectors are present and functional. CPR and First Aid expires on 3/20/2021. Licensee and assistant have complete record of immunization. Home conducts and documents fire and disaster drill every 6 months. Home has current children's roster. Children's files were randomly reviewed and found functional. LPA discussed Best Practices on Safe Sleep, US Consumer Product Safety Recall, Effects of Lead Exposure. Flyers were provided to Licensee. Home is not providing 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. Continued on 809 C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FCC AKA KIDZ CARE	FACILITY NUMBER: 406214951
	VISIT DATE: 11/20/2019

NARRATIVE

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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

In the areas evaluated, no deficiencies were cited.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPAs observed licensee post the Notice of Site visit.
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC809 (FAS) - (06/04)

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