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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700253
Report Date: 11/27/2019
Date Signed: 11/27/2019 08:13:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
197700253
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
11/27/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Chauncy & Denishay SmithTIME COMPLETED:
08:15 PM
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On November 27, 2019 at 7:15 AM, Licensing Program Analyst (LPA) King made an unannounced visit to the Smith Family Child Care Home to conduct an Increase in Capacity inspection. LPA King met with Licensees Chauncy & Denishay Smith. During visit, LPA toured the home and grounds accessible to day-care children. Currently residing in the home are the Licensees and 1 minor child. Per Licensees the following areas of the home will be utilized for the Family Child Care: 1 downstairs bedroom, 1 bathroom, living room, family room, kitchen, dining room and rear yard. LPA observed a trampoline in rear yard LPA informed licensees of the injuries reported due to the use of trampolines and informed licensees to made sure the trampoline is use as directed and age appropriate. The off-limits of the home is the entire upstairs, 3 bedrooms, 2 bathroom, loft, laundry room, and garage. The off -limit areas are made inaccessible with chid gate and proof devices. There is a fireplace located in the family room which is made inaccessible to children with a screen barrier.

Day care equipment was evaluated. There are no "bodies of water" or firearms in this home. Operable 2A10BC fire extinguisher, smoke alarm and carbon monoxide detector are operable and in place. Central heat and air are available. Safe toys, safe indoor and outdoor play areas, child safety plugs in unused electrical outlets.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197700253
VISIT DATE: 11/27/2019
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Licensee was informed that in the future if any other adult moves in and lives in this home they must be live scan cleared and TB cleared. Assistant providing care/supervisor to day care children, also need to be finger printed and cleared, TB cleared, immunized against influenza, pertussis, measles and complete the online mandated reporter training. Applicants have current CPR, First Aid Training with the expiration dates of 08/29/2020. LPA discussed the practice of fire drills at least every 6 months, and to document the time and who was present. Licensees documented fire drill was conducted on 06-15-19. Fire clearance granted 11/05/2019.

Planned hours of operation are 7 days a week from 6:00 AM to less than 24 hours.

No Incidental Medical Services (IMS) provided at this time. 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. 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

To order forms, etc. visit our website at www.ccld.ca.gov

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of the California Code of Regulations.

An exit interview was conducted, a copy of this report reviewed and provided to licensees.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2019
LIC809 (FAS) - (06/04)
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