197494655-5-12-2021-30-CC-KMIL-C2XP2Y-20210512105643

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494655
Report Date: 05/07/2021
Date Signed: 05/12/2021 10:57:10 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 CHILD CARE		FACILITY NUMBER:	197494655
ADMINISTRATOR:	SMITH, LATONYA L.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	3106635777
CITY:	VENICE	STATE: CA	ZIP CODE:	90291
CAPACITY:	14	CENSUS:	DATE:	05/07/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	LaTonya Smith		TIME COMPLETED:	02:45 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 5/7/2021 at 1:00 pm, Licensing Program Analyst (LPA) Kristina Mitchell conducted a tele-visit to the Smith Family Child Care Home for the purpose of conducting a pre-licensing tele-inspection. Due to Covid-19 the tele-inspection was conducted via FaceTime with applicant Latonya Smith. The applicant has specified that she will operate 6:00am-6:00pm Monday - Friday, serving children 6 months to 12 years of age. The applicant was advised that during hours of childcare that the applicant shall be present in the home and shall ensure children in care are always visually supervised. Residents in the home include the applicant and her daughter who is 13 years old. All areas identified on the facility sketch were inspected. The areas that were inspected were the living room, dining room, front room, 2 bedrooms, 1 bathroom, kitchen, laundry area and the exterior of the facility. Applicant stated that main care will be conducted in the living room, dining room and the designated exterior of the home that will be used for outdoor play. When entering onto the property of the home, you enter a latched gate that leads to the front yard of the home. The yard is surrounded by a brick wall that is approximately 3 ½ feet tall. This area will be supervised for the use of some outdoor play times. There are 2 sets of stairs, one leading from the driveway into the home and the other from the front yard into the home. The driveway has a latched fence as well as post in the ground that remains locked during daycare operating hours. The driveway leads to the back yard which will also be used for supervised outdoor play time, a covered patio was observed. The driveway play area is directly on the left of the home. Applicant and parent vehicles will be parked on the main street. Street sweeping is on Wednesday and Thursday and parking is available on the opposite side of the street. LPA Mitchell observed a Lego table, children’s work bench, sand table, and basketball court. The covered patio contains 3 tables with chairs, cubbies to store supplies and toys. Page 1 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

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 8

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: 197494655
	VISIT DATE: 05/07/2021

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

There are 2 stairs leading into the home from patio will not be used and door will remain locked during daycare hours. The garage is located at the end of driveway and is latched and locked with a pad lock, making it inaccessible to children in care. Garage is currently being used for storage. The backyard is cemented and has an additional latched fence and is locked with a pad lock leading to the street. Fence will remain locked during daycare hours making it inaccessible to children. Trash bins are also blocking fence.

When entering the daycare through the front of the home a COVID-19 check-in station and parent information board were observed. Due to COVID-19 licensing documents are on an easel located at front entrance of home. Upon entering the home, the living room contains toys and manipulative for children. A wood burning fireplace is fenced with screws drilled into wall. Applicant stated that the fireplace is inoperable and will remain secured and off limits to children. A television is mounted to the wall and secured.

The dining and living room are an open floor plan and are used dually. The dining room is designated for children’s arts & crafts and table work. There are 2 storage shelves containing art supplies and materials, 2 built in bookshelves and 1 chaise couch for reading. A wall heater is blocked with a built-in wooden guard which is 3” with a 6”space between, which is required by the fire department.

The front room is located directly to the right of the living room containing a kitchen play set, 2 doll houses, library and reading area with 2 small couches and children’s dining table. LPA observed 12 mats for sleeping and 1 playpen available for sleeping children. These areas will be the main daycare areas.
The dining room leads to the kitchen which is blocked with a child safety gate and are off limits. The emergency exit door is in kitchen which leads to the outdoor patio. This area contains the laundry area, emergency kits, storage and fire extinguisher. The door leading from the kitchen to outdoors is off limits and remains locked.

When exiting to the right of the dining room there is a short hallway where the children will use the bathroom and the 2 family bedrooms are located and off limits. Each bedroom door that is off limits has a child safety gate. The childcare bathroom is accessible through the hallway and is shared with applicant. Kitchen, laundry and bathroom cabinets and drawers are latched to make sharp objects, medications, toxins, poisonous items and detergents inaccessible to children in care.
Page 2 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

Page: 2 of 8

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: 197494655
	VISIT DATE: 05/07/2021

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 adequate materials and equipment that are age appropriate for children.

Children will bring lunches and water bottles from home and licensee will provide small snacks and water for children in care.

A RAST assessment due to COVID-19 was conducted and additional materials were reviewed and emailed to applicant for posting. LPA observed postings throughout the home.

Applicant stated that there are no firearms which are kept on the premises. Fire extinguisher 2A10BC is up to date and was serviced in March 2021. Applicant has Smoke Detectors located throughout the home. The fire alarm pull station and carbon monoxide detector are in the living room. Cleaning products are kept underneath the kitchen sink and laundry room above washing machine. These items are locked and made inaccessible to children in care with a child proof lock. Applicant’s First Aid/CPR Training expires 2-22-2022.

Applicant has submitted a disaster plan. The applicant has completed preventive health and safety/Childhood Nutrition and Mandated Report training. Notification of Parents’ Rights Poster and Emergency Disaster Plan are posted.

The following was discussed with the applicant:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

Page 3 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

Page: 3 of 8

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: 197494655
	VISIT DATE: 05/07/2021

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

-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.

-The fire extinguisher type 3A-40BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)

-Fire and safety drills must be performed every six months and documented for review by the Department.

-Smoking is prohibited in a family childcare home.

-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

-Dog(s) and or pets are recommended to be isolated from children in care.

- No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Page 4 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

Page: 4 of 8

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: 197494655
	VISIT DATE: 05/07/2021

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

- Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

The facility is currently providing IMS. Incidental Medical Services (IMS) policy was discussed with the applicant. 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. 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, are available at: http://www.ada.gov/childqanda.html .

Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be in children's files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the singed statement in the facility file.

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which Baby is always sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov .

In addition, LPA distributed LIC-311D and explained the following forms:

Page 5 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

Page: 5 of 8

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: 197494655
	VISIT DATE: 05/07/2021

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

LIC311D:

CHILDREN RECORDS: LIC: 700 Identification and Emergency Information, 702 Child’s Pre-admission Health History LIC 995E Caregiver Background Check Process, 995A Notification of Parent’s Rights, 627 Consent for Emergency Medical Treatment, 613A Personal Rights, LIC282 Affidavit Regarding Liability Insurance, LIC9150 Parent Notification, Additional Children in Care and Individual Infant Sleeping Plan LIC9227.

FACILITY RECORDS:

LIC9149 Property Owner/Landlord Consent, PUB 394 Notification of Parents Rights, PUB 269 California Child Passenger Safety Law, LIC 9040 Facility Roster, LIC624A Death Report, LIC6101A Emergency Disaster Plan, LIC9148 Earthquake Preparedness Checklist, LIC 624 Unusual Incident/Injury Report. LIC311D Forms/Records to keep In Your Family Child Care Home, Family Child Care Self-Assessment Guide.

STAFF RECORDS:

LIC 508 Criminal Record Statement, LIC 501 Personnel Record, LIC 503 Health Screening/TB, LIC9052 Employee Rights, LIC9108 Statement Acknowledging Requirement to Report Child Abuse, LIC 9163 Request for LIVESCAN, LIC9188 Criminal Record Exemption Transfer Request, LIC 9182 Criminal Background Clearance Transfer Request, LIC9052 Employee Rights.

The licensee was informed 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 childcare 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

Page 6 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

Page: 6 of 8

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: 197494655
	VISIT DATE: 05/07/2021

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 were also discussed with the licensee:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division
300 N. Continental Blvd., Suite 290-A El Segundo, CA 90245

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into childcare or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com.

Page 7 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: 197494655
	VISIT DATE: 05/07/2021

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

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each childcare center or family childcare home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program or an accredited college or university.

An exit interview was conducted via Tele-Visit with Applicant, LaTonya Smith. A copy of this report was issued to the applicant. A copy of this report is being emailed to the applicant and it has been explained that a reply to the email shall be considered a substitute for the hard-copy signature.

The applicant will be granted a large family childcare license for a capacity of fourteen (14) effective pending review by Licensing Program Manager.

Page 8 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

Page: 8 of 8