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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214951
Report Date: 05/16/2023
Date Signed: 05/16/2023 02:06:57 PM


Document Has Been Signed on 05/16/2023 02:06 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:GUTIERREZ FCC AKA KIDZ CAREFACILITY NUMBER:
406214951
ADMINISTRATOR:MARTHA GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 221-5534
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:14CENSUS: 11DATE:
05/16/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Martha GutierrezTIME COMPLETED:
02:15 PM
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On 5/16/23, at 1:15 PM, Licensing Program Analysts (LPAs) Elvin Baddley and Dixie Wright conducted an unannounced Case Management Legal/Non-compliance inspection of the facility. The purpose of today's inspection was to review and deliver the following legal documents to Licensee Martha Gutierrez, Decision and Order CDSS No. 641121501, effective 4/28/23.

LPAs met with Licensee and explained the nature of the visit. LPAs notes eleven children are in care at the time of the inspection. LPAs provided the Decision and Order to the Licensee. The aforementioned notes the revocation of license stayed for period of three years and the suspension of license fourteen (14) beginning on the first Monday after 30 days from effective date of order. Additionally, the aforementioned notes Licensee to operate facility in strict compliance with regulation and status governing the operations of a Family Child Care Home. The Decision and Order also notes the conditions for restoration of License.

A Notice of Site Visit (LIC 9213) along with Appeal Rights (LIC 9058) were given to the Licensee. Licensee is reminded Notice of Site Visit must remain posted to 30 days or a civil penalty of $100 may apply.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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