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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406215801
Report Date: 10/06/2023
Date Signed: 10/06/2023 04:19:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2023 and conducted by Evaluator Francisca Velazquez
COMPLAINT CONTROL NUMBER: 17-CC-20230720104459
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:14CENSUS: 1DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Michael Richardo GutierrezTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Licensee did not adhere to terms of temporary suspension order.
INVESTIGATION FINDINGS:
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On 10/6/23, Licensing Program Analysts (LPAs) Francisca Velazquez and Elvin Baddley made an unannounced inspection to the Family Child Care Home (FCCH) in order to complete the investigation of the above allegation. LPAs met with Michael R. Gutierrez, Licensee of the FCCH, and explained the nature of the inspection. LPAs note 1 child is on site at the time of the inspection, along with an Assistant providing care and supervision.

The investigation included record reviews, interviews of the Complainant, the Licensee and parents enrolled in the FCCH. Children in care were not interviewed. The allegation of the complaint referenced Licensee did not adhere to terms of temporary suspension order. License was suspended for 14 days from 5/29/23 thorugh 6/11/23. The investigation revealed corroborating information with regard to the aforementioned allegation.

CONT. LIC 9099C and LIC 9099D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 17-CC-20230720104459
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/06/2023
NARRATIVE
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Based on LPAs observation, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation, (Title 22 Division 12,102402(a)(1) is being cited on the attached LIC 9099 D).

Today, deficiency cited under Title 22 Division 12 Appeal rights given. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report.


A closing interview was conducted with the Licensee, Michael R. Gutierrez. Licensee was provided and advised of their Right to Appeal (LIC 9058). LPAs informed Licensee of the need to provide a plan of correction to CCLD as well as the time which the plan of correction needs to be submitted to CCLD.

The Notice of Site Visit (LIC 9213) was provided to the Licensee as required by H&S Code Section 1596.817.

The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 17-CC-20230720104459
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
10/09/2023
Section Cited
CCR
102402(a)(1)
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(a)The Department shall have the authority to suspend or revoke any license for the following reasons: (1) Violation by the licensee of any of the laws, rules and regulations governing family child care homes. This requirement was not met as evidenced by:
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Licensee will submit a written plan outlining how submitted documents to the local resource and referral agency will be processed accurately by 10/9/23 via email to [email protected]
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Based on record review, Licensee failed to adhere to the probation terms and conditions. Licensee's license should had been suspended for a period of 14 days from 5/29/23-6/11/23. This is an immediate risk to the health, safety and personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3