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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404803
Report Date: 10/02/2019
Date Signed: 10/02/2019 11:57:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SMITH FAMILY DAY CAREFACILITY NUMBER:
197404803
ADMINISTRATOR:GWENDOLYN SMITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 973-5192
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 0DATE:
10/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Gwendolyn Smith, LicenseeTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Shandra Powell conducted an unannounced annual random inspection to the above facility. This is a back home located behind a front home. Upon arrival LPA did not observe address posted on facility or curb. LPA was greeted at the back gate by two small dogs and observed the front door of the facility open. Licensee came to greet LPA at gate and gave tour of the home. Licensee stated she does not have any children in care during this inspection. Licensee stated she might start providing care by the end of October 2019.

This is single story 3 bedroom and 1 bath home located at the rear of a two unit property. Licensee stated she resides alone at the home. Child care is conducted in the living room, and the third bedroom children have access to the kitchen,dining area and bathroom also. Bedroom number 1 (master bedroom) and bedroom #2 are off limits. LPA advised licensee to add a child proof door knob to the master bed room door. LPA observed a child proof gate across room #2 door entrance.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, (LPA received updated telephone numbers for home and cell phones) heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children were accessible during the inspection. Licensee stated all items will be in a locked cabinet when children are in care. LPA observed broken child proof locks on cabinets and will need to be replaced before children can be in care. This poses a potential health and safety risk to children in care. LPA observed safety latches on cabinets in the kitchen needed to be replaced, the bathroom was not free of hazards.

Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. Licensee was advised that her two small dogs will have to be locked up when providing care. Licensee agreed she would have dogs locked in master bedroom during care.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SMITH FAMILY DAY CARE
FACILITY NUMBER: 197404803
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2019
Section Cited

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Operation of a Family Child Care Home
Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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LPA observed cleaning compunds, in restroom and kitchen accessible to children This poses a potential health and safety risk to children in care.
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Type B
10/31/2019
Section Cited

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Personnel Requirements

The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation
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and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. Licensee did not have a valid CPR Certification inspection.
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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.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SMITH FAMILY DAY CARE
FACILITY NUMBER: 197404803
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2019
Section Cited

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Application for Initial License
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home
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during the time that children are under care. License did not have proof of TB Clearance nor Immunizations. This poses a potential health and safety risk to children in care.
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Type B
10/31/2019
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion. Current proof of completion for each licensed
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child care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection...this poses a potential health and safety risk to children in care. Licensee has not completed training and was unaware of training.
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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.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY DAY CARE
FACILITY NUMBER: 197404803
VISIT DATE: 10/02/2019
NARRATIVE
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LPA observed required fire extinguisher smoke and carbon monoxide detector present and operable. Licensee does not have a valid CPR and First Aid Certification. Children will bring their own food and snacks will be provided per Licensee.

Children will use the outside area between homes for outdoor play time. The outdoor play area was observed to be fenced. The licensee did not have a first aid kit or supplies available.

Licensee does not have proof of immunization record and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. This poses a potential health and safety risk to children in care.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Licensee did not have a drill log available during the inspection.

Emergency Disaster Plan, Parent’s Rights Poster were not observed to be posted. LPA advised the Licensee that the required forms to be posted need to be visible at all times.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensee states that she is not currently caring for infants. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, (Mandated Reporter Training) and provided licensee with a copy of the PUB 271 Never Ever Shake a Baby pamphlet. LPA also provided licensee with a copy of Forms/Records to Keep In Your Family Child Care Home (LIC311D).

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY DAY CARE
FACILITY NUMBER: 197404803
VISIT DATE: 10/02/2019
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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: http://www.ada.gov/childqanda.htm.

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com



LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov
LPA received licensee email address to add to CCLD website to receive important updates.

Based on the LPAs observations the following deficiencies listed on the attached LIC 809 deficiency page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Gwendolyn Smith, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5