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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215941
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:22:42 PM

Document Has Been Signed on 09/08/2022 03:22 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GUTIERREZ FCC AKA KIDS ON THE MESAFACILITY NUMBER:
406215941
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Fallon GutierrezTIME COMPLETED:
03:30 PM
NARRATIVE
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On September 8, 2022 at 12:00 PM, Licensing Program Analyst Gigi Reyes conducted an unannounced 1 Year Required and Capacity Increase Inspection. LPA asked pre screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID-19 exposures on site. LPA met with licensee, Ms. Fallon Gutierrez and discussed the purpose of the inspection. There were 5 napping children when LPA arrived.

Licensee/Applicant submitted the application for increase in capacity on August 8, 2022. LPA and Licensee toured the interior and exterior of the day care. Family Child Care Home (FCCH) has a dedicated room for childcare located at the far back of the home. LPA observed required licensing forms are posted in the FCCH. LPA observed smoke and carbon monoxide detectors in the FCCH. The regulation fire extinguisher was serviced on 6/29/2022. Home conducts and documents fire and disaster drill every month, last drill was conducted on 6/3/2022. The bathroom is located outside the day care room attached to the main home and was observed to be clean and free of toxins. Licensee accompanies the children to use the bathroom The play yard is fully fenced. The garages and main home are inaccessible to day care children. Licensee stated that guns and ammunition are locked separately in a place inaccessible to day care children.

During the tour, Licensee/applicant informed LPA that a swimming pool was built in May 2021. Licensee did not notify CCL prior to the construction of the in ground pool and did not submit the permit issued by the City and the updated Facility Yard Sketch. She stated that she verbally informed Community Care Licensing (CCL) after its construction. The swimming pool is located approximately 150 feet away from the day care, in an area that is not accessible to day care children.
Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FCC AKA KIDS ON THE MESA
FACILITY NUMBER: 406215941
VISIT DATE: 09/08/2022
NARRATIVE
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The swimming pool is enclosed with a 5 feet high fence with a self-latching gate that opens away from the pool. LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 5/4/2024. Licensee did not renew the Mandated Reporter Training Certificate which expired on 7/5/2022.

FCCH has current roster of children in care. A sampling of children records was reviewed and found to be current. File contains Emergency and Identification card requirements. Currently the licensee does not have liability insurance and had signed waivers in each child's file that was reviewed.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FCC AKA KIDS ON THE MESA
FACILITY NUMBER: 406215941
VISIT DATE: 09/08/2022
NARRATIVE
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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.

During today's inspection deficiencies were cited under Title 22 Division 12

Fire safety inspection clearance was granted on August 9, 2022, however , issuance of Large Family Child Home License is pending until the Plan of Corrections are submitted to CCL on or before September 18, 2022.

Exit interview was conducted and report was reviewed with Ms. Fallon Gutierrez. A notice of site visit was given and must remain posted for 30 days.


SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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Document Has Been Signed on 09/08/2022 03:22 PM - It Cannot Be Edited


Created By: Gigi Reyes On 09/08/2022 at 02:21 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FCC AKA KIDS ON THE MESA
FACILITY NUMBER: 406215941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in licensee did not renew the mandated reporter training certificate that expired on 7/5/2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2022
Plan of Correction
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Licensee agreed to submit plan of correciton to CCL no later thatn 9/19/2022. Licensee agreed to take mandated reporter training and written statement to ensure that the said training will be renewed in a timely manner.
Type B
Section Cited
CCR
102416.3(a)(3)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (3) Installation of in-ground or above-ground swimming pools, spas, fish ponds, decorative water feature, fountains or other bodies of water.

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 Licensee did not notify the department prior to construction of in ground swimming pool whihc poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2022
Plan of Correction
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Licensee agreed to submit a written plan of correction to ensure that any alterations in the existinig buildings and grounds will be reported to CCL prior to changes. POC will be sumitted to CCL no later than 9/19/2022
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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022


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Document Has Been Signed on 09/08/2022 03:22 PM - It Cannot Be Edited


Created By: Gigi Reyes On 09/08/2022 at 02:21 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FCC AKA KIDS ON THE MESA
FACILITY NUMBER: 406215941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above Licensee stated she physically checks napping infants every 15 minutes but failed to document which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2022
Plan of Correction
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Licensee agreed to document the every 15 physical and visual checking of napping infant and submit a written plan of correction to CCL no later than 9/19/2022.
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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022


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