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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845463
Report Date: 04/30/2026
Date Signed: 04/30/2026 10:01:21 AM

Document Has Been Signed on 04/30/2026 10:01 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
334845463
ADMINISTRATOR/
DIRECTOR:		GUTIERREZ, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 379-1145
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
04/30/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Angelica GutierrezTIME VISIT/
INSPECTION COMPLETED:
10:10 AM
NARRATIVE
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On April 30, 2026, at 09:30 AM, Licensing Program Analyst (LPA) Courtnee Peebles, arrived for the purpose of opening up a complaint investigation for the Gutierrez Family Child Care. During the inspection, LPA reviewed records and toured the facility inside and out with licensee and the following health and safety concerns were noted and photos were taken, which resulted in a separate case management deficiency issued separate from the complaint investigations.

During the facility tour LPA Peebles observed two sleeping infants in two separate pack and plays with bottles hanging out of their mouths, pillows underneath their heads, and rolled up blankets on each side of their bodies. All hazardous items were removed from the sleeping infants pack and plays during the visit putting the facility back into compliance. Furthermore during the visit, LPA conducted a file review and found that sleep logs are not completed for napping infants in care. Licensee stated she was unaware of the requirement for the age of the infant napping and although is completing the 15 minute sleep checks visually, she had not documented them on a sleep log.

Based on records review and LPA’s observations, the facility is being cited for: Title 22, division 12, 102425 (c)Infant Safe Sleep, 102425 (j)(D) Infant Safe Sleep, see 809D for deficiencies.

Exit interview was conducted, and a copy of this report, 809D’s and appeal rights were provided to licensee, Angelica Gutierrez.

A notice of site visit was provided and licensee was informed it must be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Courtnee Peebles
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2026
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 3
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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Document Has Been Signed on 04/30/2026 10:01 AM - It Cannot Be Edited


Created By: Courtnee Peebles On 04/30/2026 at 09:23 AM
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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 334845463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2026
Section Cited
CCR
102425(b)

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(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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Licensee removed the blankets and pillows that were placed in the pack and play with the sleeping infants putting the facility back into compliance.
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Based on observation, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care. There were two infants in care that were sleeping in a pack and play with pillows underneath their heads and blankets on each side of their body.
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Type B
04/30/2026
Section Cited
HSC102425(j)(1)

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The provider shall supervise infants while they are sleeping and adhere to the following requirements:

(1) The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
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The licensee stated they will begin conducting 15 minute sleep logs and ensure they are readily avaialble upon request.
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Based on observation, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care. The licensee has not condcuted a sleep log for sleeping infants in care.
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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.
Pauline Beschorner
NAME OF LICENSING PROGRAM MANAGER:
Courtnee Peebles
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2026


LIC809 (FAS) - (06/04)
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