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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406214951
Report Date: 07/20/2021
Date Signed: 07/20/2021 02:08:56 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2021 and conducted by Evaluator Melissa K Stewart
COMPLAINT CONTROL NUMBER: 17-CC-20210514130509
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
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Martha GutierrezTIME COMPLETED:
01:29 PM
ALLEGATION(S):
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Child is being cared for at a different licensed facility without parent's consent
Licensee is requesting parents to sign a "blank" sign in/out sheet
INVESTIGATION FINDINGS:
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On 7/20/21 at 9:10 AM, Licensing Program Analysts (LPAs) Melissa Stewart and Martina Jimenez conducted an unannounced inspection to conclude the complaint investigation of the allegations above. LPAs met with Licensee, Martha (aka Kathy) Gutierrez and explained the nature of the inspection. A risk assessment for COVID19 exposure was conducted with Licensee prior to LPAs entry into the home. LPAs observed that Licensee, Assistants and children ages two (2) years and above were not wearing face coverings indoors. LPAs toured the home and inspected each room upstairs. There were 14 children (including 2 infants) present when LPAs arrived at the facility. Licensee reported that she had not yet subscribed to receive the Provider Information Notices (PIN) via email. LPA explained the importance of reviewing all PINs available on the website (www.cdss.ca.gov) in order to be informed regarding current guidance related to COVID19. LPA provided LIcensee with a copy of PIN-21-18-CCP and CDPH Guidance for Child Care Providers and Programs dated 6/29/21. Licensee instructed adults and children to put on their masks.

continued on 9099-C
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 17-CC-20210514130509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 07/20/2021
NARRATIVE
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On 5/21/21, witnesses observed seven (7) children and two (2) adults, one of which was identified as Licensee, Michael Gutierrez, walking from 1713 Kleck Rd to 1717 Kleck Rd at 8:23am. When questioned by LPA Jimenez on 7/20/21, Licensee Martha Gutierrez reported that Licensee Michael Gutierrez had an emergency and asked that five (5) children be dropped off at 1713 Kleck Rd. for about 15 to 20 minutes.

On 6/24/21 at 10:09am, witnesses observed Licensee, Michael Gutierrez, adult Assistant, two (2) school aged children and one (1) infant (carried by Michael Gutierrez) exit 1713 Kleck Rd and walk down the sidewalk, passing 1715 Kleck Rd. and up the driveway of 1717 Kleck Rd.

On 7/20/21, LPA Stewart reviewed CAPSLO Certificate/Attendance Records at Martha Gutierrez FCC (1713 Kleck Rd). Based on review of CAPSLO Certificate/Attendance Records for July 2021 parents of six (6) children had signed the form prior to all of the times and dates of attendance being filled in.

Interviews were conducted with parents of children who are either currently attending or have recently attended the Family Child Care (FCC) of Licensee, Michael Gutierrez FCC (1717 Kleck Rd) and/or Martha Gutierrez FCC (1713 Kleck Rd). Two (2) out of eight (8) parents interviewed reported that although their child(ren) were enrolled at Michael Gutierrez FCC, they dropped off and/or picked up their child(ren) at Martha Gutierrez FCC on several occasions. Both parents indicated that they had been instructed by Licensee(s) to pick up or drop off at an FCC that was not the FCC where their child was enrolled.

Licensee acknowledges that children have been dropped off at 1713 Kleck Rd on two (2) occasions in 2021. Licensee denied that children enrolled at Michael Gutierrez' FCC had been transferred from his FCC to her FCC to be picked up by parents at 1713 Kleck Rd.
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Continued on 9099-C
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
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 17-CC-20210514130509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 A
07/20/2021
Section Cited
CCR
102417
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102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home.... When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence....
This requirement is not met as evidenced by:
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Licensee stated that it is not acceptable for Michael Gutierrez to request that children enrolled at his FCC be dropped of at her FCC. Licensee will submit a written plan of correction regarding her decision to no longer allow children other than those enrolled at her FCC to be left in her care to LPA Stewart via email or mail on or before Friday, 7/23/21 at 5pm.
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Based on interviews conducted, parents of three (3) children (C29, C30 and C26) enrolled at Michael Gutierrez' FCC located at 1717 Kleck Rd. reported that they dropped their child off at 1717 Kleck Rd and were asked to pick up their child from 1713 Kleck Rd on several occassions. These children were not enrolled at Martha Gutierrez' FCC...
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and were transferred from one licensed FCC to another without prior consent by the child's parent. Licensee, Martha Gutierrez, permitted Licensee, Michael Gutierrez to transfer the children from his care and supervision rather than arranging for a susbstitute adult to supervise and care for the children enrolled at his FCC in his own home.
Type A
07/20/2021
Section Cited
CCR
102402(a)(3)
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102402 Revocation or Suspension of a License (a)The Department shall have the authority to suspend or revoke any license for the following reasons: (3) Conduct in the operation ... of a family day care home which is inimical to...the individual....or the people of the State of California.
This requirement is not met as evidenced by:
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Licensee stated that she will create a letter explaining to parents the importance of not signing the attendance record prior to their child's last day of attendance each month. Licensee will ensure that each parent reads and understands this procedure and will follow up with parents immediately if/when they sign prior to their child's last day.
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Based on record review, parents of six (6) children (C1, C3, C4, C9, C10 & C15) had signed the CAPSLO certificate/ attendance record dated July 2021 prior to all of the times and dates of attendance being filled in. Licensee did not ensure that the attendance record were being signed by parents after the completion of the month in order to accurately
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reflect the dates and times children attended care.
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
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 17-CC-20210514130509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 07/20/2021
NARRATIVE
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Based on LPAs observations, interviews which were conducted, documents gathered and/or record review, the preponderance of evidence standard has been met, therefore the above allegations are found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, are being cited on the attached LIC 9099D.

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.

Upon receipt, provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. (LIC 9224 was provided to Licensee).

LPA observed Notice of Site Visit posted.

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
LIC9099 (FAS) - (06/04)
Page: 4 of 4