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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016431
Report Date: 12/04/2024
Date Signed: 12/04/2024 04:26:32 PM

Document Has Been Signed on 12/04/2024 04:26 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
198016431
ADMINISTRATOR/
DIRECTOR:		GUTIERREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 639-4548
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
12/04/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Maria Gutierrez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 12/4/24 at 12:45pm Licensing Program Analysts (LPAs) Alicia Mooberry and Joshua Ortega conducted a Required Annual Inspection in Spanish. Upon arrival, LPAs met with Maria Gutierrez Licensee, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. There were 8 children present, including 5 infant. Children's file review completed at 2:00pm confirmed that the facility is operating over the licensing capacity from LPAs arrival until 1:30pm ( one out of 5 infants was picked up by parent. Licensee was reminded that operating over the licence capacity poses an immediate risk to the health and safety of children in care.

Also present was Noemi Cabrera, Assistant. All adults present have been cleared and associated to the facility. Individuals residing in the home were discussed and noted. Licensee provides care to children ages newborn to 12 years old and operation days/ hours are Monday through Friday 6:00AM to 6:00PM.

This is a single-story home. The home consists of 2 bedrooms, 1 bathroom, living room, dining area, kitchen, family room (day care room), patio, back yard with patio (fenced), front yard and garage.



At 12:50pm LPAs observed Fabuloso cleaner on the ground by sink located by door to the back patio, there were 5 children present supervised by Staff #1 and licensee, LPA Mooberry instructed licensee to removed the cleaner and it was moved to inaccessible area upon request. Accessibility to cleaning agents poses an immediate risk to children in care.

Areas accessible to children include the living room, dining area, kitchen, bathroom, family room and back patio.


Areas off limits to children include both bedrooms, front yard, backyard (fenced) and garage. The children use the bathroom located in the hallway. The restroom that children use was observed safe and sanitary.
Rooms that are off-limits were observed to be closed and need to be made inaccessible during operating ------------Page 1 – Report Continues
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016431
VISIT DATE: 12/04/2024
NARRATIVE
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The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.
LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted. Licensee was advised to post the required posted documentation in a location visible to parent/guardians of children in care. LPA reviewed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 5/29/24. The home maintains telephone service via cell phone/LAN line. The home is observed to be clean and orderly.

There are toys and other age-appropriate material available. LPA observed that cleaning compounds are in kitchen inaccessible to children in care.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home No bodies of water located on the premises of the home.

Isolation area for sick children waiting to be picked up is in daycare room, supervised and away from the other children.

The Licensee is providing. LPA discussed the safe sleep regulations with licensee 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 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.

The outdoor play area was observed to be fenced with age appropriate toys and other materials for children to play with. LPAs observed a medium sized dog in the separate backyard area, inaccessible to children in care.


-------------------Page 2 – Report Continues
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016431
VISIT DATE: 12/04/2024
NARRATIVE
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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months). Licensee was reminded to log the children's sleep time.

Licensee and staff records were reviewed, Staff #1 has an incomplete file, missing documents include Immunization record (MMR, TDap, TB), Mandated Reporter Certificate, LIC 9108. which poses a potential risk to the health and safety of children in care.

This licensee is not providing Incidental Medical Services – IMS. LPA reviewed PIN 22-02-CCP.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Based on the LPA's observations and records review the facility is cited 2 "A" and 1 "B" are cited today in accordance with California Title 22 Regulations.

Due to "A" deficiencies cited: A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form LIC 9224 during this visit. A copy of the Parent Notification Requirements was also provided to the licensee/Director.

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. Appeal rights were discussed and a copy provided in Spanish.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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Document Has Been Signed on 12/04/2024 04:26 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 12/04/2024 at 02:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that there was a bottle of all purpose cleaner (Fabuloso) on the ground by sink located by door to the back patio accessible 5 children present which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/04/2024
Plan of Correction
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Licensee removed the cleaner and placed it in locked cabinet. Per licensee,
Type A
Section Cited
CCR
102416.5(d)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 5 out of 8 children present are under the age of 24 months which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/04/2024
Plan of Correction
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During this inspection 3 out of 5 infants were picked up by parent/guardian. Per licensee, there are currently 5 infants enrolled and she will eithther disenroll 1 infant or change children's schedule to be in compliance with capacity. A written statement wil be provided to the department by 12/5/24
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:Denise Gibbs
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/04/2024 04:26 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 12/04/2024 at 02:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that Staff #1 does not have Immunizations on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/11/2024
Plan of Correction
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Per licensee and Staff #1 proof of immunizations will be sent to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Denise Gibbs
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


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