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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515408176
Report Date: 09/15/2022
Date Signed: 09/15/2022 01:13:30 PM

Document Has Been Signed on 09/15/2022 01:13 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:GUTIERREZ, ALMA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515408176
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/15/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Alma GutierrezTIME COMPLETED:
01:20 PM
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A prelicensing inspection was conducted ton 9/15/2022 at 11:40am by Licensing Program Analyst (LPA), Laura Chavez. LPA met with applicant Alma Gutierrez. The applicant is requesting a license for a capacity of 8. The facility will operate Monday-Friday, 4:30am to 5:30pm. The residence is a 3 bedroom/2 bath single story home. There are 2 adults and 3 minors currently living in the home. The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: garage, 3 bedrooms and master bathroom. These areas have been made inaccessible by means of locks, chain latches and doorknob covers. The poisons are locked in a shed located outside of the fenced in play area. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The applicant stated that the fireplace in the living-room is non-operational. The applicant understands that the fireplace shall be securely screened if used while children are in care. The children will use a fenced in area of the backyard as the outdoor play area. The backyard is completely fenced. There is no pool, spa, pond, fountain, or any other body of water on the premises. LPA reviewed with applicant Alma Gutierrez the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. The applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. Report continued: See LIC809-C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: GUTIERREZ, ALMA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515408176
VISIT DATE: 09/15/2022
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LPA discussed the safe sleep regulations with applicant Gutierrez and discussed the Child Care Licensing Safe Sleep web page at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-
resources/safe-sleep as an additional resource. LPA also informed applicant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at: https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe
and select the Child Care option to receive email communication.

The following item is needed prior to the granting of license:
1. Proof of making the door in the playroom which leads to the side of the home
inaccessible to children.

Exit interview conducted and report was reviewed with applicant Alma Gutierrez.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
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