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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400147
Report Date: 11/16/2022
Date Signed: 11/16/2022 01:00:32 PM

Document Has Been Signed on 11/16/2022 01:00 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
198400147
ADMINISTRATOR:GABRIELLA GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 422-7712
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 6DATE:
11/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Assistant - Gabriela Guitierrez LopezTIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required one year inspection to the above facility on 11/16/22. LPA arrived at the facility at 9:50 AM and met with assistant Gabriela Guitierrez Lopez, who guided analyst on a tour of the facility. Also present during this inspection was second assistant S2. Per assistant, there are 11 children that are currently enrolled. There were 5 children and 1 infant present upon arrival.

This is a single-story home which consists of 3 bedrooms, 2 bathrooms, kitchen/dining room, 2 living rooms, a detached garage, front yard and backyard (fenced). The off limit areas include 2 bedrooms, 1 bathroom, detached garage, and front yard.

The main care area is located in bedroom 1. LPA observed sleeping cots, age appropriate toys, art supplies, children reading materials, storage cubbies, a wall mounted television and a Babytrend pack and play. LPA observed a storage bag with infant toys hanging on the side of the pack and play. LPA advised assistant that a citation under California Code of Regulation (CCR) Section 102425(b)(3) will be issued. Living rooms 1 and 2 are also used for care and were observed to be free of any loose or pointy parts. The bathroom designated for children in care was observed to be clean with an operable sink and toilet. Child locks were observed beneath the bathroom sink making the cleaning supplies inaccessible to children in care. LPA observed the kitchen cabinets to have child proof locks. Knives and other sharp or pointy objects were not observed to be accessible in the kitchen. The outdoor play area is located in the backyard and was observed to have perimeter fencing, various outdoor play equipment for children, patio furniture, a storage shed and a camper. A white fence and gate with lock was observed around the camper making it inaccessible to children playing in the back yard. A locked storage shed containing boxed food items and additional cleaning supplies was observed in the back yard play area. A jacuzzi with a locked cover was also observed in the backyard play area. Access to the off limits detached garage is located in the back yard. LPA did not
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 11
Document Has Been Signed on 11/16/2022 01:00 PM - It Cannot Be Edited


Created By: Randy Derraco On 11/16/2022 at 12:24 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: 198400147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)(3)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, a storage hanger containing infant toys was observed hanging on the side of a pack and play used by an infant in care, which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Assistant states she and licensee will review PIN 20-24-CCP - Recently Approved Safe Sleep Regulations and CDSS Infant Safe Sleep webpage.
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 observation, interview and record review, immunization records were not maintained for S2 in the family child care home, which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Assistant states she and licensee will update personal records and send photos of imuunization records to LPA via email
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022


LIC809 (FAS) - (06/04)
Page: 2 of 11
Document Has Been Signed on 11/16/2022 01:00 PM - It Cannot Be Edited


Created By: Randy Derraco On 11/16/2022 at 12:24 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: 198400147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022

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
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Based on observation, interview and record review, LPA did not observe a completed personnel record maintained in the family child care home, which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Assistant state she and licensee will update personal records and add LIC 501 for all employees.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, LPA did not observe immunization records maintaned in the family child care home for C1 and C6 which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Assistant states she and licensee will email LPA copies of immunization reocrds for C1 and C6.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022


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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198400147
VISIT DATE: 11/16/2022
NARRATIVE
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observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. LPA observed 3 pets dogs kept in bedroom bedroom 2.

Assistant states that she provides food for children in care. Safety gates were observed at the entrance of the hallway and the entrance to bedroom 1. Per assistant, isolation area for children showing signs of illness will be located in living room 1 or 2 while they await parent pick up. Smoking is prohibited in a licensed Family Child Care Home. Per assistant, no one smokes in the home.

Individuals who reside in the home were noted and discussed. 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.

Assistant states that there are no firearms stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA observed a wall heater to be barricaded in the day care area. The assistant states that there are no poisons in the home and understands that storage areas for poisons must be locked, not just inaccessible.



The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 06/10/22, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

LPA discussed the safe sleep regulations with assistant 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 assistant 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
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC809 (FAS) - (06/04)
Page: 10 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 198400147
VISIT DATE: 11/16/2022
NARRATIVE
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equipment.

Both assistants have completed training on preventive health practices including Pediatric First Aid and CPR. The assistants Pediatric First Aid and CPR expires on 01/2023 and 01/2024. LPA observed that both assistants have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. File review was observed to not have a complete personal record for S2. Missing items include assistant's full name, date of employment, current home address and phone number. LPA advised assistant that a citation under CCR Section 102416.1(a) will be issued. LPA did not observe immunization documents for S2 maintained at the facility. LPA advised assistant that a citation under Health and Safety Code (HSC) Section 1597.622(c) will be issued. Children’s records were reviewed, including emergency information. LPA observed that C1 and C6 did not have immunization records on file. LPA advised assistant that a citation under CCR Section 102418(g) will be issued. A current children’s roster was available for review.

Incidental Medical Services (IMS):


IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22 and California Health and Safety Code. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeal rights provided, and report was reviewed with the Assistant Gabriela Guiterrez Lopez. (page 3 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC809 (FAS) - (06/04)
Page: 11 of 11