406214951-7-20-2021-17-CC-MMUR-C5YPY5-20210817114318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 406214951
Report Date: 07/20/2021
Date Signed: 07/20/2021 02:14:04 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
06/24/2021 and conducted by Evaluator Martina Jimenez

COMPLAINT CONTROL NUMBER: 17-CC-20210624152317

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: 14	DATE:	07/20/2021
		UNANNOUNCED	TIME BEGAN:	01:56 PM
MET WITH:	Martha Gutierrez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Lack of supervision resulting in day care child wandering from the facility.

INVESTIGATION FINDINGS:

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On 7/20/2021 at 1:56 PM, Licensing Program Analysts (LPAs) Martina Jimenez and Melissa Stewart, conducted an unannounced 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 6/24/2021, LPAs Martina Jimenez and Gigi Reyes conducted a Case Management Inspection for the allegation of the Lack of supervision resulting in day care child wandering from the facility. The incident was documented, cited and SUBSTANTIATED, on the Case Management Inspection conducted on 6/24/2021.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
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)

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