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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215801
Report Date: 05/16/2023
Date Signed: 05/16/2023 02:40:27 PM

Document Has Been Signed on 05/16/2023 02:40 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 CARE AKA KIDZ KLUBHOUSEFACILITY NUMBER:
406215801
ADMINISTRATOR:MICHAEL RICHARDO GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 835-3741
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
05/16/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Michael GutierrezTIME COMPLETED:
03:30 PM
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On 5/16/23, at 2:25 PM, Licensing Program Analysts (LPAs) Elvin Baddley and Dixie Wright conducted an unannounced Case Management Legal/Non-compliance inspection of the facility. The purpose of today's inspection was to review and deliver the following legal documents to Licensee Michael Gutierrez, Decision and Order CDSS No.6421121502, effective 4/28/23.

LPAs met with Licensee and explained the nature of the visit. LPA notes ten children are in care at the time of the inspection. LPAs provided the Decision and Order to the Licensee. The aforementioned notes the revocation of license stayed for period of three years and the suspension of license fourteen (14) beginning on the first Monday after 30 days from effective date of order. Additionally, the aforementioned notes Licensee to operate facility in strict compliance with regulation and status governing the operations of a Family Child Care Home. The Decision and Order also notes the conditions for restoration of License.

A Notice of Site Visit (LIC 9213) along with Appeal Rights (LIC 9058) were given to the Licensee. Licensee is reminded Notice of Site Visit must remain posted to 30 days or a civil penalty of $100 may apply.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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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