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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215801
Report Date: 06/29/2023
Date Signed: 06/29/2023 04:35:13 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/29/2023 04:35 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 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: 7DATE:
06/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:12 PM
MET WITH:Michael GutierrezTIME COMPLETED:
05:00 PM
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On 06/29/23, at 3:12 PM, Licensing Program Analyst (LPA) Dixie Wright conducted a unannounced Required Comprehensive Annual inspection of this Family Child Care Home (FCCH). LPA met with Michael Gutierrez, Licensee, and toured the interior and exterior of the FCCH. The living room, downstairs hallway bathroom, and the backyard are used for child care, while the remainder of the home is excluded. LPA observed seven children on site, (one is an infant) along with one assistant, (cleared and associated).

LPA observed required licensing forms and documents posted on the wall in the entryway. LPA observed a smoke and carbon monoxide detectors in the FCCH. Smoke alarm was tested at 3:44 and functioning. The carbon monoxide detector was tested at 3:46 PM and functioning. The FCCH has a regulation fire extinguisher which was serviced on 05/09/2023. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually.

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. Medications are stored in an elevated cabinet in the kitchen which is inaccessible to children. LPA observed cleaning compounds in an elevated cabinet in the kitchen which is inaccessible to children. Sharps in the FCCH are stored in an elevated cabinet in the kitchen which is inaccessible to children.

The backyard is enclosed by wooden fencing and the footing in the area is cement. Toys and play equipment observed on site are age appropriate. The fence’s entry/exit gate is secure. LPA observed no bodies of water on site.
Children's records were reviewed. The records are current, complete and possessed emergency contact information as well as immunization records. LPA also reviewed documentation noting
(CONT. LIC 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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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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 FAMILY CHILD CARE AKA KIDZ KLUBHOUSE
FACILITY NUMBER: 406215801
VISIT DATE: 06/29/2023
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the infant's sleep checks have been conducted in 15 minute intervals on both infants in care. The Licensee's records were also reviewed and found to be current. Pediatric CPR and First (EMSA approved) expires on 05/16/2025. Mandated Reporter certificate expires on 06/28/2025. Last fire drill was done on 06/24/2023. Licensee stated no firearm or ammunition is stored on site.

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 [email protected]. 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 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.

LPA discussed the safe sleep regulations with licensee 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 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, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE AKA KIDZ KLUBHOUSE
FACILITY NUMBER: 406215801
VISIT DATE: 06/29/2023
NARRATIVE
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Licensee [or facility representative] 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, Licensee Michael Gutierrez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

No deficiencies observed at this visit.

Exit interview conducted and report was reviewed with the licensee Licensee Martha Gutierrez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC809 (FAS) - (06/04)
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