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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215801
Report Date: 11/01/2023
Date Signed: 11/01/2023 11:38:36 AM

Document Has Been Signed on 11/01/2023 11:38 AM - 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: 9DATE:
11/01/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Michael GutierrezTIME COMPLETED:
11:45 AM
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On 11/1/2023, Licensing Program Analysts (LPAs) Francisca Velazquez and Elvin Baddley conducted an unannounced Annual Continuation Required Inspection of the Family Child Care Home (FCCH). LPAs met with Michael Gutierrez, licensee FCCH and explained the purpose of the inspection. LPAs, in the company of licensee toured the interior and exterior of the FCCH. LPAs notes nine (9) children were present during today’s inspection being cared by licensee and assistant, Saveena Corona.

This is a two story home with five (5) bedrooms, four (4) bathrooms, day-care area, living room, dining room, kitchen, laundry room, garage, and outdoor yard. The day-care services occur in the day-care area, bathroom, and outdoor yard. Meanwhile, the rest of the home is inaccessible to children in care. LPAs observed a secured gate on the first step of the stairway making the entire second floor inaccessible to children in care. Additionally, LPAs observed a secured gate making the kitchen, living room, and dining area inaccessible. Lastly, LPAs observed locks on the laundry room, garage and bedroom located on the first floor.

LPAs observed the home to be orderly. There is plenty of ventilation to afford the children comfort. LPAs observed sharps are stored in an elevated cabinet in the kitchen. Cleaning compounds are stored in the laundry room and elevated cabinet in the kitchen. Medication for the family is stored in an elevated cabinet in the kitchen and in the bedrooms, all of which are inaccessible to children in care. The restroom that is used for childcare services is clean and free of toxins. In the FCCH, LPAs observed toys, furniture, and equipment are in good conditions and are age appropriate for the children in care.

Required forms are predominantly posted in the day-care room wall. LPAs observed a smoke detector that was tested and operable at 10:20 AM. LPAs observed a carbon monoxide detector in the FCCH that was tested and operable at 10:20 AM. LPAs observed the home has a regulation fire extinguisher that was serviced on 5/9/23. LPAs reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 KLUBHOUSE
FACILITY NUMBER: 406215801
VISIT DATE: 11/01/2023
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 Licensee informed LPAs there are no guns or ammo stored in the home.

LPAs observed the outdoor yard to be completely fenced. LPAs observed the exit doors to be secured. LPAs observed that part of the outdoor yard is made inaccessible by means of fencing. The outdoor yard provides plenty of shading for the children in care. Licensee will be removing degrading items from the outdoor yard. Filtered drinking water is provided by means of individual cups. Toys, furniture, and equipment observed in the outdoor yard are age appropriate. No bodies of water are observed.

LPAs reviewed Licensee, assistant, and children's records. The children’s records were found to contain emergency contact information as well as immunization records. Licensee is documenting infant 15-minute sleep logs for all children under the age of two (2) years. LPAs reviewed the facility roster that contained the names of all children present during inspection. The last emergency drill was conducted and documented on 06/24/2023. LPAs reviewed Licensee’s Pediatric First -aid certificate that expires 5/16/25 and Licensee’s Mandated Reporter training certificate expires on 6/28/25. LPAs reviewed Assistant Pediatric First -aid certificate that expires 7/15/25 and Assistant’s Mandated Reporter training certificate expires on 6/28/25.

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.

LPAs 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. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUTIERREZ FAMILY CHILD CARE AKA KIDZ KLUBHOUSE
FACILITY NUMBER: 406215801
VISIT DATE: 11/01/2023
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 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 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, the 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.

Exit interview conducted and report was reviewed with the licensee, Michael Gutierrez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
LIC809 (FAS) - (06/04)
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