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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417900
Report Date: 02/06/2025
Date Signed: 02/06/2025 01:03:54 PM

Document Has Been Signed on 02/06/2025 01:03 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GUTIERREZ, BLANCAFACILITY NUMBER:
434417900
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:13 AM
MET WITH:BLANCA GUTIERREZTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 2/6/2025, at 9:13 AM, Licensing Program Analyst (LPA) Liridon Fici- Doni arrived unannounced to conducted an Annual inspection. LPA met with Licensee, BLANCA GUTIERREZ and explained the reason for the inspection, and also Licensee applied for a change of capacity from a small Family Child Care Home (FCCH) to a large FCCH. Licensee has at least one year of experience as a licensee of a small FCCH to apply for a large FCCH. A fire clearance was granted on 01/22/2025. There were three (3) children and two (2) staff present during today's inspection.

There is an area to post required postings, such as license and notification of parent's rights. The hours of operation are Monday through Saturday from 5AM to 6PM. Licensee does have liability insurance and is on file . The department received a copy of the Licensee's rental agreement which is on file.

LPA toured the inside and outside of the home with Licensee. The off-limit areas of the home are the Bedrooms, closets, garage, office area, pantry and the entire upstairs. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. There are toys and equipment for children. There is a fully charged fire extinguisher that was last serviced on 1/5/2025, along with working smoke and carbon monoxide detectors that are interconnected. The last fire/disaster drill was conducted on 12/6/2024. Licensee stated that there are no weapons, such as firearms, stored in the home.

The backyard and front yard is used by children and LPA observed the backyard is fenced. LPA observed a swimming pool that has a gate around it that is 60 Inches tall and 4 inches in width which meets the pool safety requirements per CCL regulation...

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ, BLANCA
FACILITY NUMBER: 434417900
VISIT DATE: 02/06/2025
NARRATIVE
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Licensee understands that she needs to supervise children when using the front and back yard. There are toys and equipment for children. LPA reminded Licensee to check all plastic play structures for any cracks.

Licensee does transport children and does have a valid driver's license. Licensee understands that children cannot be left alone and unattended in parked vehicles.

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.

Incidental Medical Services (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 stated children will not be given any kind of medication while the child is in care.

LPA reviewed with the Licensee LIC 311D- Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the Licensee...

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ, BLANCA
FACILITY NUMBER: 434417900
VISIT DATE: 02/06/2025
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LPA discussed required postings with Applicant and provided copies of Parents Rights bulletin (PUB394) and Earthquake Preparedness Checklist (LIC9148). LPA discussed Provider Information Notices (PINs). LPA additionally reviewed CCLD website and online annual fee payment.

During record review, Licensee and Staff file were reviewed for the following records: Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). Licensee has a current Mandated Reporter Training and was conducted on 11/19/2024. Licensee has current Pediatric CPR/FIRST AID that was conducted on 10/18/2023. LPA informed Licensee that Mandated reporting and First aid/CPR is mandatory and should be renewed every 2 years.



LPA reviewed three (3) children's file and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file. LPA observed 15-minute sleep logs for an infant in care. A copy of the facility roster was obtained during today's inspection.

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.


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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ, BLANCA
FACILITY NUMBER: 434417900
VISIT DATE: 02/06/2025
NARRATIVE
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LPA reminded Licensee that when Licensee does not have an assistant, Licensee can only care for up to 8 children at any one time in the home.

Licensee is the only adult living in the home. Licensee was reminded that all adults 18 and over living or working in the home, including 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.

During the exit interview, the Licensee, BLANCA GUTIERREZ, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was advised that upon review and approval of Licensing Program Manager (LPM), a license for a large Family Child Care Home will be granted and issued.

No deficiencies were issued as a result of this 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, BLANCA GUTIERREZ.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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