<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493807
Report Date: 01/17/2020
Date Signed: 01/17/2020 03:05:05 PM

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 CHILD CAREFACILITY NUMBER:
197493807
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
01/17/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Cynthia Smith-LicenseeTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 01/17/2020 at 1:30 PM, Licensing Program Analysts (LPA) Adrian Risher conducted an announced Case Management visit for the purpose of an inspection for a proposed capacity increase. LPA met with Cynthia Smith and toured the facility inside and out. The facility is applying for a capacity increase from 8 children to 14 children. Upon arrival, 3 children were observed napping with 1 staff member. LPA observed 2 infants outside with assistant. Hours of operation are Monday through Friday from 7:00 AM – 6:30 PM. The fire clearance was granted on 01/03/2020 by Inspector Lamorris Wilcher.

This is a single-family home that has 5 bedrooms and 3 bathrooms. The daycare will consist of 3 bedrooms and 1 bathroom. These areas were inspected by LPA. The other bedrooms and rooms are considered off-limits and inaccessible. Applicant is renting the home. Applicant provided property owner/landlord consent form with the application. The master bedroom is used for daily activities including napping. The first bedroom right across from the dining room is used as the infant room. The bedroom behind the dining room is used for daily activities and playing. The children utilize the bathroom on the back porch. The children eat in the nook right off of the kitchen. LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. Detergents are stored on top of the refrigerator. LPA observed pots and pans in the kitchen cabinets.

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197493807
VISIT DATE: 01/17/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed age appropriate toys, furniture and activities for children while in care at the facility. LPA observed slides, tables, scooters, tricycles, and toys in the outside play area. The outside play area is gated all around.

LPA observed a charged fire extinguisher (2-A:10-B:C). LPA tested the smoke detector and carbon monoxide detector. All electrical outlets, detergents, cleaning supplies and medications are inaccessible to children. Applicant has a first aid kit which includes tweezers, band aids and a thermometer. The home has central heating. Licensee stated that she uses window air conditioning systems during the warmer weather.

Applicant has current CPR, first aid, health and safety which expires 04/2020. The assistant's cpr card expires july 2021. Per the applicant, there are no firearms on the premises. Applicant reports that there are no pets in the home. There are no bodies of water at the home. . LPA did not observe any baby walkers, exersaucers or bouncers.



The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible. LPA observed the fire drill log. Licensee conducted a fire drill in August 2019.

Copies of immunization records and mandated reporter training has been reviewed and completed.


page 2
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
LIC809 (FAS) - (06/04)
Page: 2 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197493807
VISIT DATE: 01/17/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The following was discussed with the licensee:
The licensee was informed to have a qualified assistant when the capacity exceeds 8 children. The assistant must be at least 14 years of age, but can not be left alone with the children in care. If the assistant is 18 years of age and older, the assistant must have current Adult/Infant & Pediatric First Aid certificates if left alone with children while the licensee is out of the home. Each assistant must also have TB clearance, valid criminal record clearance, immunizations and be associated to the facility license.


A license to operate a Large Family child care home will be reviewed following final administrative review. No license will be issued today 01/17/2020.

Exit interview and copy of report provided. Appeal rights have been reviewed and provided.

page 3

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3