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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406215801
Report Date: 07/20/2021
Date Signed: 07/20/2021 05:30:57 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-20210514132545
FACILITY NAME:GUTIERREZ FAMILY CHILD CARE AKA KIDZ KLUBHOUSEFACILITY NUMBER:
406215801
ADMINISTRATOR:MICHAEL RICHARDO GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 835-3741
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:14CENSUS: 10DATE:
07/20/2021
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Michael GutierrezTIME COMPLETED:
04:06 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 3:20PM, Licensing Program Analysts (LPAs) Melissa Stewart and Martina Jimenez conducted an unannounced inspection regarding the complaint allegations above. LPAs met with Licensee, Michael 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 was implementing the COVID 19 mitigation plan; face coverings were worn indoors by all persons 2 years and older. LPAs toured the home and inspected each room upstairs. There were 10 children (including 3 infants) present when LPAs arrived at the facility.

On 5/21/21, witnesses observed seven (7) children and two (2) adults, one of which was later identified as Licensee, Michael Gutierrez, walking from 1713 Kleck Rd to 1717 Kleck Rd at 8:23am. When questioned by LPA on 5/21/21, Licensee reported that four (4) children had been dropped off at 1713 Kleck Rd. and that this is not a regular occurrence.
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 7
Control Number 17-CC-20210514132545
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 FAMILY CHILD CARE AKA KIDZ KLUBHOUSE
FACILITY NUMBER: 406215801
VISIT DATE: 07/20/2021
NARRATIVE
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On 5/21/21, LPA Stewart reviewed CAPSLO Certificate/Attendance Records at Michael Gutierrez FCC (1717 Kleck Rd). Based on review of CAPSLO Certificate/Attendance Records for May 2021 which were submitted to CAPSLO by Michael Gutierrez FCC, parents of seven (7) children had signed the form prior to all of the times and dates of attendance being filled in.

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

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 different from the FCC where their child was enrolled.

Licensee denied that children enrolled at his FCC have been dropped off or picked up at Martha Gutierrez' FCC on several occasions. Licensee acknowledges that on 5/21/21, he had an emergency at his child's school and neither of his Assistants were unavailable to receive the children in his place on that day. Licensee stated that he contacted parents by phone call to get a verbal confirmation that they would drop their child(ren) off at Martha Gutierrez' FCC.

Based on LPAs observations, interviews which were conducted, documents gathered and/or record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, are being cited on the attached LIC 9099D.

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: 2 of 7
Control Number 17-CC-20210514132545
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 FAMILY CHILD CARE AKA KIDZ KLUBHOUSE
FACILITY NUMBER: 406215801
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(a)
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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 he now understands that children enrolled at his FCC can only be supervised and cared for at his licensed facility location. Licensee stated that if he has an emergency in the future, he will contact the parents and let them know that the child care will not be open at the usual time.
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Based on interviews conducted, parents of C9, C10 and C16 reported that children were taken to another licensed FCC without prior consent by the child's parent. Licensee did not ensure that Licensee was present or arranged for a substitue adult to care for and supervise the children during Licensee's absence from the FCC which poses....
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Licensee will submit a written plan of correction to LPA Stewart via email or mail on or before Friday 7/23/21 at 5pm.



an immediate risk to the health and/or safety of children in care.
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 he will explain to the parents (both verbally and in writing) regarding the importance of signing the CAPSLO Attendance/Record on the child's last day of attendance each month. Licensee will submit a written plan of correction to LPA Stewart via email or mail on or before Friday 7/23/21 at 5pm.
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Based on record review, parents of seven (7) children (C3, C4, C9, C10, C11, C13 & C14) had signed the CAPSLO certificate/ attendance record dated May 2021 prior to all of the times and dates of attendance being filled in. Licensee did not ensure that the attendance accurate and complete attendance record was being signed by parents prior to
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submitting the record to CAPSLO for payment of child care services rendered by the Licensee.
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: 3 of 7
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-20210514132545

FACILITY NAME:GUTIERREZ FAMILY CHILD CARE AKA KIDZ KLUBHOUSEFACILITY NUMBER:
406215801
ADMINISTRATOR:MICHAEL RICHARDO GUTIERREZFACILITY TYPE:
810
ADDRESS:1717 KLECK ROADTELEPHONE:
(805) 835-3741
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:14CENSUS: 10DATE:
07/20/2021
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Michael GutierrezTIME COMPLETED:
04:06 PM
ALLEGATION(S):
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Licensee is not present
INVESTIGATION FINDINGS:
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On 7/20/21 at 3:20 PM, Licensing Program Analysts (LPAs) Melissa Stewart and Martina Jimenez conducted an unannounced inspection regarding the complaint allegations above. LPAs met with Licensee, Michael 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 was implementing the COVID 19 mitigation plan; face coverings were worn indoors by all persons 2 years and older. LPAs toured the home and inspected each room upstairs. There were 10 children (including 3 infants) and one Assistant present when LPAs arrived at the facility.

It was reported that Licensee, Michael Gutierrez, has a second job in addition to providing child care services and that communication regarding children is handled by Licensee, Martha Gutierrez (1713 Kleck Rd.) When questioned by LPA Stewart on 7/20/21, Licensee stated that he has not held another job since becoming a licensed child care provider in July 2019. Licensee stated that he communicates with the parents of children in care at drop off and pick up time. continued on 9099-C
Unsubstantiated
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: 4 of 7
Control Number 17-CC-20210514132545
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 FAMILY CHILD CARE AKA KIDZ KLUBHOUSE
FACILITY NUMBER: 406215801
VISIT DATE: 07/20/2021
NARRATIVE
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Interviews were conducted with six (6) 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). Two (2) out of six (6) parents interviewed reported that they were not satisfied with the care, supervision and level of communication with Licensee. The remaining four (4) parents reported that they were satisfied with the care, supervision and communication provided by Licensee, Michael Gutierrez. Parents reported that they dropped their children off with Licensee, Michael Gutierrez or an Assistant. None of the parents interviewed corroborated the allegation that Licensee is not present at the FCC.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiency cited, today.

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
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 17-CC-20210514132545
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 FAMILY CHILD CARE AKA KIDZ KLUBHOUSE
FACILITY NUMBER: 406215801
VISIT DATE: 07/20/2021
NARRATIVE
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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, Michael 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).

LPAs observed the 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: 7 of 7