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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493807
Report Date: 07/22/2021
Date Signed: 07/22/2021 03:37:04 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:SMITH, CYNTHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 219-4107
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:14CENSUS: 6DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:36 PM
MET WITH:Cynthia Smith - LicenseeTIME COMPLETED:
03:52 PM
NARRATIVE
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On 7/22/2021 at 2:36 P.M. Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced 1 year required/Annual Random visit for Smith Family Child Care Home (FCCH). Present in the home were the Licensee, 1 assistant (S1) and 6 child care children; 2 infants and 4 day care aged children. The home was inspected inside and out according to the facility sketch for health and safety compliance per Title 22.
Day care operations took place in the dining room, and three other rooms of the home. The licensee operates a center based home.

LPA observed the following:
Care and supervision were observed, two infants were observed under supervision of the assistant in what was identified as the baby room. Standard cribs were observed, with no drop down sides.
No baby bouncers or walkers were observed
The homes capacity was within the scope of the license
Appropriate size fire extinguisher carbon and smoke detector present & operable.
Detergents, and knives were made inaccessible to children in care
No guns or weapons present as stated by the Licensee, no weapons observed by LPA.
Properly working telephone pg.1 of 2
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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 2
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: 07/22/2021
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License, facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights Poster and California Safety Seat Law are posted
Both persons in the home had current Pediatric CPR and First Aid training expiring 6/6/2023
No bodies of water on the premises were observed.
Children records available and in good order.
Current Mandated certificates were provided, expiration date 6/10/2023
Toys, equipment and materials available and in good order
LPA did not observe any hazardous conditions in the outdoor activity area.
Covid 19 guidelines were adhered to; postings, social distancing and mask were observed

No citations were issued during todays visit, an exit interview was conducted and a copy of this report was provided to the licensee.

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SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2