566206746-1-11-2024-17-CC-GGOZ-CZE3GQ-20240111171444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566206746
Report Date: 01/11/2024
Date Signed: 01/11/2024 05:14:52 PM

Document Has Been Signed on 01/11/2024 05:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GUTIERREZ FAMILY CHILD CARE		FACILITY NUMBER:	566206746
ADMINISTRATOR:	MARIA GUTIERREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 336-9215
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	14	CENSUS: 3	DATE:	01/11/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:39 PM
MET WITH:			TIME COMPLETED:	05:20 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	On January 11, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Required 3 - Year inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with FCCH's assistant and spoke to Licensee Maria Gutierrez on the phone who arrived at 2:55PM. LPA informed Licensee and the assistant the purpose of the inspection. LPA in the company of an assistant toured the interior and exterior of the FCCH. At the time of the inspection 3 children were in care. The FCCH uses the living room, dining room, playroom and 2 bathrooms for child care purposes. LPA observed the living room and dining room to be free of hazards. LPA observed the kitchen to be accessible to children and observed that all the cabinets were free of hazards. LPA observed the knives to be stored on an elevated surface beyond the reach of children. LPA observed medications to be stored in an elevated cabinet in the hallway. LPA reminded Licensee that in order for rooms to be considered inaccessible they need to remain locked. LPA observed the play room to have age appropriate toys and furniture. LPA observed the bathrooms used for childcare to be clean and free of hazards as well. LPA observed the required licensing forms to be posted. LPA observed FCCH to have a functioning fire alarm which was tested at 2:09PM. The FCCH has a regulation fire extinguisher which was serviced on 11/03/2023. LPA reminded Licensee to to either service or purchase a regulation fire extinguisher annually. The backyard is completely enclosed, with toys and equipment for children of various ages. LPA observed 2 storage shed that were unlocked that did not contain any potential hazards. LPA advised Licensee that if they were to store hazardous materials in the sheds to ensure that they remain locked. LPA observed a trampoline as well which remained secured. LPA reminded Licensee that they need to ensure that the trampoline needs to be age appropriate. LPA observed both side gates to be secured with latches beyond the reach of children. CONTINUED PAGE 2

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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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Document Has Been Signed on 01/11/2024 05:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 566206746
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 1 records which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/25/2024
	Plan of Correction
1 2 3 4	Licensee will create files for their assistant and anyone who helps with the children. Licnensee will also include proof of Pediatric CPR/First aid as well. Licnsee will submit proof of files via email to LPA at giovani.gonzalez.@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 566206746
	VISIT DATE: 01/11/2024

NARRATIVE

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Children's records were reviewed which were found to be current and complete. LPA requested the assistants file, however Licensee stated that they were not aware that they needed one for their assistant. LPA reviewed Licensees files as well. Licensee's stated that they completed their Pediatric CPR/First Aid and Mandated Reporter Training however, does not know where they are.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
CONTINUED PAGE 3

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 566206746
	VISIT DATE: 01/11/2024

NARRATIVE

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Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During todays inspection 1 Type B deficiency was issued. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Maria Gutierrez

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC809 (FAS) - (06/04)

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