<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216922
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:45:35 PM

Document Has Been Signed on 12/05/2024 04:45 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
SANTA BARBARA CC RO, 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: 7DATE:
12/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:07 PM
MET WITH:Michael GutierrezTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/05/2024, at 2:07 PM, Licensing Program Analyst (LPA) Joaquin Mendez conducted an unannounced Annual Random/Comprehensive inspection of the abovementioned Family Childcare Home (FCCH). LPA met with Michael Gutierrez, Licensee of the FCCH and explained the nature and purpose of the inspection. It is noted Decision and Order CDSS No .6421121502, dated 1/30/23, notes Michael Gutierrez's licensee 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 to be granted a probationary license subject to the limitations and specified conditions. LPA notes seven children are on site, along with 2 assistants (cleared and associated) providing care and supervision.

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 located at the upper portion of the parent bulletin board, predominantly visible to parents during drop-off and pick-up.

The LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH is a four-bedroom, three bathrooms, two story dwelling. The FCCH’s living room, first floor bathroom and backyard are used for children care services, while the remainder of the home is excluded from care. The FCCH was observed to be clean and orderly.
· LPA 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.
· Required forms are predominantly posted on the wall near the entry of the FCCH.
· The FCCH’s living room has a fireplace which is screened by glass.
· The FCCH's bathroom used for childcare services is observed to be clean and free of toxins.
Continue on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 12/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
· LPA observed combination smoke and carbon monoxide detectors throughout the FCCH. A combination detector in the family room was tested at 2:31PM and found to be operable.
· The FCCH has a regulation fire extinguisher on site which was serviced on 5/15/24. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually.
· The FCCH maintains working telephone services.
· Medication in the home is the bedroom in the upper story of the home which is excluded from care.
· Cleaning compounds are stored in a secured laundry room in an elevated cabinet which is inaccessible to children in care.
· Sharps are observed in an elevated location in the kitchen cabinets which is inaccessible to children in care.
· Toys, furniture, and equipment in the FCCH are age appropriate. LPA reminded the licensee to make daily checks to play structures prior to use for the safety of children.

LPA conducted a records review of all children enrolled in the FCCH, along with all staff members. All records are current and completed.
· LPA reminded 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.
· CPR certification expires 5/16/2025.
· Mandated reporter certificate expires 6/28/2025. LPA reminded licensee to complete Mandated Reporter Training and CPR every (2) two years.
· Fire/earthquake drill last conducted 6/16/2024 with 7 children present.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee Michael Gutierrez was reminded that all adults 18 and over living or working in the home, including
Continue on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 12/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Michael Gutierrez 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 [or facility representative] 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 Licensee Michael Gutierrez is not providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee Michael Gutierrez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Michael Gutierrez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 12/05/2024.

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

No deficiencies were cited during today's inspection.

Continue on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE
FACILITY NUMBER: 406216922
VISIT DATE: 12/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4