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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192004902
Report Date: 10/16/2024
Date Signed: 10/16/2024 12:00:26 PM

Document Has Been Signed on 10/16/2024 12:00 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
192004902
ADMINISTRATOR/
DIRECTOR:		GUTIERREZ, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 262-6507
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY: 12TOTAL ENROLLED CHILDREN: 13CENSUS: 4DATE:
10/16/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Leticia Gutierrez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On October 16, 2024, an unannounced Case Management - Plan of Corrections (POC) inspection was conducted by Licensing Program Analyst (LPA) Staicy Perry to ensure Type A deficiency issued on 10/16/2024 were cleared. LPA Perry met with licensee Leticia Gutierrez. Census was taken and LPA Perry observed 4 children in care with 2 staff. Facility is operating in ratio for a Large Family Child Care Home.

Today, LPA Perry observed and obtained documents of licensee Leticia and assistant Jasmine's video summaries of what was learned from video on CDSS CCLD website on "How Many Children Can Attend A Family Child Care Home". LPA observed and obtained video summaries with signatures and dates and LPA did not observe facility to be operating out of ratio. Per licensee, assistant is now working 9:00 am-4:00pm or more if needed. LPA did observe facility to be operating in ratio and licensed capacity.

LPA provided the facility with a "Letter of Deficiency Citations Cleared." Letter must be filed in facility for three years and upon request made accessible to the public for review.

Per Chapter 3, Division 12, Title 22 Regulations no deficiencies are observed today.

LIC9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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