<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214951
Report Date: 12/24/2021
Date Signed: 12/24/2021 02:02:11 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: 2DATE:
12/24/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Martha GutierrezTIME COMPLETED:
02:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA) Martina Jimenez who met with Licensee, Martha Gutierrez.

The purpose for this inspection is to provide the Licensee with a copy of an Accusation for case CDSS No. 642121501B to revoke Gutierrez Family Child Care aka Kidz Care license.

It is noted in the Accusation that the Department is seeking a revocation of the Family Child Care license that is held by Martha Gutierrez.

A copy of the Accusation Summary indicating the Departments intent to revoke the license of this family child care home shall be provided to the parent/guardian of any currently enrolled child by the next business day or immediately upon return as well as the parent/guardian of any enrolled child until the accusation is either dismissed or resolved through the administrative hearing or stipulated agreement. The following documentation was provided and explained:

· Accusation
· Acknowledgement of Receipt of Licensing Reports (LIC 9224)
· A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained.
· Licensee’s signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2021
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 2
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: 12/24/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Exit interview conducted with Licensee, Martha Gutierrez.

Notice of Site Visit has been posted (LIC9213).



The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2