197495702-2-20-2026-30-CC-JLAO-DRGV64-20260220150854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495702
Report Date: 02/20/2026
Date Signed: 02/20/2026 03:09:18 PM

Document Has Been Signed on 02/20/2026 03:09 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	GUTIERREZ-DUBOSE FAMILY CHILD CARE		FACILITY NUMBER:	197495702
ADMINISTRATOR/ DIRECTOR:	ANA GUTIERREZ-DUBOSE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 773-1344
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	02/20/2026
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Ana Gutierrez-Dubose		TIME VISIT/ INSPECTION COMPLETED:	11:15 AM

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On 02/20/2026 Licensing Program Analyst (LPA) Judy Laureano conducted announced inspection with applicant Ana Gutierrez-Dubose. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes.

The applicant is applying for a change of location of a Large Family Child Care Home license for a max capacity of 12. Applicant has been licensed as a Large FCCH since 11/02/2011. Control of property was submitted to the El Segundo Child Care Regional Office for review. Applicant confirmed that living in the home is applicant, applicant’s husband and two small dogs.

Fire Clearance was completed on 2/19/26 by Inspector G. Lopez

Per the application, at this time, the ages the applicant wishes to provide services for, are children ages 3 months to 5 years old- Monday through Friday from 7:30 a.m. to 5:30 p.m. Applicant is not available for overnight or weekend care. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department via LIC 279 approval prior to the initiation of changes.

LPA toured the home inside and outside.The home is a single-family home with 4 bedrooms and 2 bathrooms, living room, dining room, kitchen and detached garage. Applicant confirmed the following areas are used for day care: living room, dining room area, bedroom 1, bedroom 2 and bathroom outside the dining room space. License confirmed younger children will nap in bedroom 1 and 2^nd bedroom will be used as an activity space. The enclosed back yard has been designated as daycare space.

Applicant has two small dogs that will remain in the detached garage area and/or master bedroom (bedroom 4), both areas have been designated as OFF LIMITS to the children in care.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUTIERREZ-DUBOSE FAMILY CHILD CARE	FACILITY NUMBER: 197495702
	VISIT DATE: 02/20/2026

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Parents will access the home through the main entrance, which leads you to the living room space, dining room area and kitchen; open floor plan. Living room and dining room area have been designated as day care space.

LPA observed children’s cubbies and a mounted working fire extinguisher. The living room and dining room area were observed with a variety of children’s books, puzzles and dramatic play area. A barricaded fire place was observed in the living room space. The applicant confirmed children eat and nap in the area. LPA observed a working smoke detector and carbon monoxide detector.

The kitchen was observed and inspected. LPA observed all kitchen cabinets to have safety latches making the content inaccessible to the children in care. Refrigerator, stove and counter space were observed and inspected. The applicant confirmed home provides meals and snacks. LPA discussed the importance of having policies in place to ensure that all who help with care and supervision are aware of any dietary restrictions and/or allergies. LPA also encouraged applicant to contact their local Resource and Referral agency, Connections for Children, to inquire about any food programs and/or other professional development opportunities and resources. Kitchen will be used as a walkway to access the back yard.

Next to the living room/dining room area a small hallway was observed that leads to the bedrooms and bathroom.

The bathroom that children use was inspected. Sink, toilet and bathtub were observed and inspected. All bathroom cabinets were observed. LPA reminded applicant that all toiletries in bathroom will need to remain inaccessible to the children in care during the hours of operations.

Bedroom 1 was observed and inspected. LPA observed napping cots, pack and plays in the space. LPA observed a closet that is used to store children’s napping cots.

Bedroom 2 was observed and inspected. LPA observed a changing table, soft toys and materials for children to use.

Next to the bedroom 2, bedroom 3 and the main bedroom and bathroom were observed; these areas have been designed as OFF LIMITS to the children in care, doors will remain locked/closed while children are present. LPA observed a sliding door outside the main bathroom (bathroom 2) that leads to the back yard and patio. Applicant confirmed children will not have access to the space.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUTIERREZ-DUBOSE FAMILY CHILD CARE	FACILITY NUMBER: 197495702
	VISIT DATE: 02/20/2026

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Applicant confirmed the following areas as OFF LIMITS to the children in care: Bedroom 3, main bedroom (bedroom 4) and bathroom (bathroom 2) and detached garage. LPA reminded applicant that all areas designated as OFF LIMITS, doors will remain closed and/or locked during the hours of operations and/or while children are present.

There are no firearms or ammunitions on the premises. All electrical outlets in the home were observed covered. LPA observed applicant test carbon monoxide and smoke detectors in the home. A working fire extinguisher and Push Alarm located the dining room area. No bodies of water were observed in the home.

The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

The following corrections will need to be completed by 2/27/2026.
Stove knob covers are needed due to the kitchen being used as a walkway.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The applicant provided proof of control of property. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC 9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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, available at: http://www.ada.gov/childqanda.htm

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GUTIERREZ-DUBOSE FAMILY CHILD CARE	FACILITY NUMBER: 197495702
	VISIT DATE: 02/20/2026

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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for and removing 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.

On this date, 01/07/2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the applicant Ana Gutierrez-Dubose.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC809 (FAS) - (06/04)

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