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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214951
Report Date: 07/20/2021
Date Signed: 07/20/2021 02:11:55 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: 14DATE:
07/20/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Martha GutierrezTIME COMPLETED:
01:55 PM
NARRATIVE
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On 7/20/21 at 1:30 PM, Licensing Program Analysts (LPAs) Melissa Stewart and Martina Jimenez conducted an unannounced Case Management inspection in regard to complaint investigation # 17-CC-20210514130509 to document a deficiency cited.

During the course of the complaint investigation, LPA received documentation that Licensee, Martha Gutierrez, had been informed on 1/13/21 that child #1 (C1), enrolled at Michael Gutierrez' FCC, had tested positive for COVID19. On 1/16/21, Licensee was informed that two (2) members of C1s family had also tested positive. On 1/23/21, Licensee was informed that one member of the family had been hospitalized. Although this information was provided directly to Licensee, Martha Gutierrez did not ensure that this information was reported to Community Care Licensing Department (CCLD) as required.

Licensee denies this instance of receiving information regarding C1 testing positive for COVID19. Licensee acknowledged that C1s parent did disclose to Licensee, that both parents had tested positive. Licensee stated that she did not know that she was required to report the parents' positive test result to CCLD.

Deficiency cited today in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee, Martha Gutierrez, whose signature on this form confirm receipt of these documents.

LPA observed Licensee post Notice of Site Visit.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2021
Section Cited

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102416.2 Reporting Requirements
(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.
This requirement is not met as evidenced by:
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Based on information received, Licensee, Martha Gutierrez was informed on 1/13/21, 1/16/21 and 1/23/21 regarding C1 (enrolled at Michael Gutierrez' FCC) and C1s family members who tested positive for COVID19. Licensee did not report these positive cases to CCLD per regulation noted above which poses a potential risk to
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the health and/or 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: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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