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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216922
Report Date: 08/15/2024
Date Signed: 08/15/2024 12:24:52 PM

Document Has Been Signed on 08/15/2024 12:24 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 FAMILY CHILD CAREFACILITY NUMBER:
406216922
ADMINISTRATOR/
DIRECTOR:		GUTIERREZ, MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 835-3741
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Michael GutierrezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 8/15/14, at 9:15 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual Random/Continuation Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Michael Gutierrez, Licensee of the FCCH and explained the nature and purpose of the inspection. The Inspection follows a previous inspection which was conducted on 8/14/24 at the site. LPA notes Decision and Order CDSS No. 6421121502, dated 1/30/23, indicates Michael Gutierrez's license to operate a FCCH is revoked. The revocation of the license is stayed, for a period of three years during which time Michael Gutierrez is be granted a probationary license subject to the limitations and specified conditions.

LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH is a four bedroom, three bathroom, two story dwelling. The FCCH’s living room, first floor bathroom and backyard are used for children care services, while the remainder of the FCCH is excluded from care. LPAs observed a child safety gate at the base of the stairwell serving as a barricade to the FCCH’s upper story. A retractable mesh fence is also observed at the entry of the FCCH’s kitchen. LPAs note six children are on site, along with an Assistant (cleared and associated) providing care and supervision.

LPA conducted a records review of all children enrolled in the FCCH, along with all staff members. All records are current and completed. LPA remained LIcensee to ensure Acknowledgment of Licensing Report forms (LIC 9224) should be completed for all children in care, as well as newly enrolled children in the FCCH. Further, LPA informed Licensee to ensure parents of children in care are provided one LIC 9224 for each proceeding event/report.

LPA reviewed posted documents/forms and notes required documents/forms are posted on the wall near the entry of the FCCH. LPA observed the Decision and Order CDSS No. 6421121502, which is noted near the lower portion of the a parent bulletin board. LPA informed the Licensee the Decision and Order should be posted in a predominant location which is visible to all individuals entering the FCCH. Accordingly, Licensee
(CONT. 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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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 FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 08/15/2024
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relocated the Decision and Order top portion of the parent bulletin board.

No deficiencies were cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Michael Gutierrez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
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