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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008164
Report Date: 02/12/2020
Date Signed: 02/12/2020 04:34:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
198008164
ADMINISTRATOR:SMITH, STEPHANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 804-3301
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:14CENSUS: 6DATE:
02/12/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Stephanie SmithTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced annual inspection. LPA met with Licensee, Stephanie Smith, who guided analyst on a tour of the facility. There were 6 children present, 2 being infants. Licensee states that there are currently 4 children enrolled, children's roster was reviewed and is current. Per licensee operating hours are from 6:30 AM - 6:00 PM, Monday - Friday.

This is a single story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, living room and backyard (fenced). Care is mainly provided in the day care space located in the rear of the home. Licensee has a child proof gate isolating the remainder of the home. There is a third bathroom located in the day care space used by children in care.

Per licensee, areas off limits to children and parents include: the 3 bedrooms, living room, dining room and front yard. The licensee provides food for children in care. Residing in the home is one adult and no children.

All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.

The LPA toured all areas used by children during this visit. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas of the home. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198008164
VISIT DATE: 02/12/2020
NARRATIVE
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Per licensee, there are no weapons, firearms or bodies of water on the premises. There were safe toys, play equipment and materials observed for children. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. Children’s records were reviewed to ensure that each child has an Identification and Emergency form and Consent for Medical Treatment on file. The valve on the required 2A10BC fire extinguisher indicates fully charged. LPA did not observe a service tag indicating that last date of service. Smoke detector and carbon monoxide detector were tested and are in operable condition. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 1/05/2020. The licensee has current Pediatric First Aid and CPR, which will expire 2/29/2020.

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. 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

AB 1207: Beginning on January 1, 2018, this law 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. Proof of certificate is on file.

PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198008164
VISIT DATE: 02/12/2020
NARRATIVE
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Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room.

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

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

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

Based on the LPA’s observations and records review, 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.



Exit interview was conducted with Stephanie Smith. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198008164
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2020
Section Cited

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102417(g)(1)
Operation of a Family Child Care Home
The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: The home shall contain a fire extinguisher .. This requirement is not met as evidence by:
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Based on LPA observation of missing service tag which poses a potential health and safety risk to children in care.
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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: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2020
LIC809 (FAS) - (06/04)
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