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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214951
Report Date: 06/24/2021
Date Signed: 06/24/2021 06:03:49 PM

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: 8DATE:
06/24/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Martha GutierrezTIME COMPLETED:
05:00 PM
NARRATIVE
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On 6/24/2021 at 9:50 AM, Licensing Program Analysts (LPAs) Gigi Reyes and Martina Jimenez conducted an unannounced Case Management inspection at Gutierrez Family Child Care Home. LPAs met with Martha Gutierrez, Licensee. LPAs advised the Licensee of nature and purpose of the inspection. Prior to entering the FCCH, LPA asked Licensee Pre Screening questions related to COVID-19. Licensee's responses suggest no COVID exposure on site.

On 6/23/2021, at or about 1:20 PM during nap time, a 26 month old child (herein referred to as Child #1) walked out the door, left FCCH without the knowledge of Staff # 1 who was supervising the 11 napping children. Staff 2 was on the other room watching two infants.

Based on the interview conducted with Licensee and Staff #1, Staff #1 thought that all 11 children were sleeping, Staff #1 proceeded to the kitchen and washed dishes, at that point Child 1 exited the front door unnoticed by Staff 1 and Staff # 2. Staff #1 stated it took 10 minutes before Staff # 1 realized Child # 1 was missing as opposed to statement of Staff #2 2 that it took about 30 minutes. Licensee stated that during the time of the incident, Licensee went to Community Health Clinic (CHC ) to get TB Test.

On 6/24/2021, LPAs traveled along the street where Child # 1 was found - Montebello Oaks Drive a street perpendicular to Kleck Road where FCCH physical address is located.
Continued on LIC 809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FCC AKA KIDZ CARE
FACILITY NUMBER: 406214951
VISIT DATE: 06/24/2021
NARRATIVE
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Based on LPAs measurement, Child #1 walked along a street sidewalk an estimated 1512 feet more or less from the FCCH unsupervised by Licensee or Assistant for about 31 minutes. Child was walking barefoot under 83 degree Fahrenheit weather.

LPAs interviewed Adult #1 who observed the child in front of their home walking along the bike lane. Adult #1 stepped out of Adult #1's home and followed along Child # 1, observing if Child #1 had adult companion. After another 455 feet, Adult # 1 decided to talk to Child #1 when Adult #1 determined Child # 1 was unaccompanied. Child# 1 crossed 2 streets with moving vehicles running 35 to 40 miles an hour (25 mph). Adult #1 contacted Paso Robles Police Department( PRPD) and PRPD returned Child # 1 to Family Child Care Home.

Based on the Incident Report, interview with Licensee and Staff, PRPD Call Service Report - (CSP) and LPAs observations, deficiencies were cited under Title 22 Division 12 of California Code of Regulations Chapter no. 102432 (a)(2) and 102417 (a)

An exit interview was conducted with Licensee. Appeal Rights were given and explained to the Licensee. LPA discussed and explained the FCCH's required plan of correction.

Licensee was provided the Acknowledgement of Receipt (LIC 9224). Parents shall receive a copy of 9099, 9099C, and 9099D. Each parent/guardian shall sign an LIC 9224 with copies maintained in each child's file. Every parent enrolling a new child in the FCCH shall receive a copy of the report and sign a LIC 9224 for the next twelve months. A copy of this report was reviewed and provided to the Licensee.



LPAs observed Licensee posted Notice of Site (LIC 9213) visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FCC AKA KIDZ CARE
FACILITY NUMBER: 406214951
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2021
Section Cited

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Operation of a Family Child Care Home
The licensee shall be present in the home and shall ensure that children in care are supervised at all times.
This requirement is not met as evidenced by:
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On 6/23/2021, Licensee self reported an incident of a day care child who wandered away on the same day. Licensee and/or assistant failed to supervise a C1 who wandered down the street 3 blocks away from FCCH without supervision. This poses an immediate risk to health and safety of children in care.
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Type A
06/25/2021
Section Cited

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Personal Rights
To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement is not met as evidenced by:

On 6/23/2021, Licensee self reported an incident of a day care child (C1) who wandered away unnoticed from their care.
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 The 26 month old child was found by a stranger who walked about 3 blocks away from FCCH without shoes under 83 degrees Fahrenheit weather. This poses an immediate risk to health and safety of children in care.

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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2021
LIC809 (FAS) - (06/04)
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