426210490-8-8-2023-17-CC-GGOZ-CUJ238-20230808170155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426210490
Report Date: 08/08/2023
Date Signed: 08/08/2023 05:02:11 PM

Document Has Been Signed on 08/08/2023 05:02 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GUTIERREZ FCC AKA ELENA'S DAYCARE		FACILITY NUMBER:	426210490
ADMINISTRATOR:	ROSA GUTIERREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 291-6971
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	08/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Rosa Gutierrez		TIME 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 8/8/23 at 3:30PM Licensing Program Analyst Giovani Gonzalez conducted an unannounced Annual Inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with Licensee Rosa Gutierrez and explained the purpose of the inspection. LPA and the Licensee toured in interior and the exterior of the FCCH. The home's downstairs family room, backyard, and downstairs bathroom are used for child care, while the remainder of the home is excluded. LPA observed 11 children in care at the time of the inspection. LPA observed age appropriate toys, furniture and equipment in the FCCH's interior. LPA observed the restroom used by children in care to be clean and free of toxins. Licensee's medications, sharps and cleaning compounds are in an excluded area of the FCCH. LPA observed required licensing forms and documents posted on a wall in the family room used for child care. LPA observed smoke and carbon monoxide detectors upstairs and downstairs. The upstairs carbon monoxide detector was tested at 3:27PM and was found to be operational. The downstairs fire detector was not tested because there were children sleeping, however the Licensee stated that they changed the batteries for the detectors about two weeks ago. The FCCH has a regulation fire extinguisher which was purchased 6/3/23. LPA reminds the Licensee to either service or purchase a regulation fire extinguisher annually. LPA observed that the stairs to the upper level of the home is gated. The backyard has toys and play equipment that is for children of various ages. LPA reminds Licensee that the children must be supervised to ensure that they are using the toys that are age appropriate to them. LPA also observed a shed that is locked and inaccessible to the children in care. LPA observed that the backyard is enclosed by a wooden fence. LPA observed that the backyard also has stairs to the upper floor of the home which is blocked off by a gate. CONT 809C -->

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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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Document Has Been Signed on 08/08/2023 05:02 PM - It Cannot Be Edited

Created By: Giovani Gonzalez On 08/08/2023 at 03:59 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 ELENA'S DAYCARE	FACILITY NUMBER: 426210490
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview the licensee did not comply with the section cited above in 1 out of 1 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/22/2023
	Plan of Correction
1 2 3 4	Licensee will provide a copy of the infant sleep logs to LPA by 08/22/23. Licensee will email these copies to giovani.gonzalez@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ana Tolentino

LICENSING EVALUATOR NAME:

Giovani Gonzalez

LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GUTIERREZ FCC AKA ELENA'S DAYCARE	FACILITY NUMBER: 426210490
	VISIT DATE: 08/08/2023

NARRATIVE

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A sampling of the children's records were reviewed. Licensee had current records, however the Licensee stated that they were not logging the infant sleep. Licensee's records were also reviewed and found to be current. Pediatric CPR expires on 01/08/24 and their Mandated Reporter expires on 4/3/24.

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

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.

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 for additional resource. LPAs 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.

One Type B Deficiency was given. See LIC809D A Notice of Site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Rosa Gutierrez .

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC809 (FAS) - (06/04)

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