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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012661
Report Date: 07/13/2022
Date Signed: 07/13/2022 01:18:07 PM


Document Has Been Signed on 07/13/2022 01:18 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
198012661
ADMINISTRATOR:SMITH, TARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 351-5240
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:14CENSUS: 7DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Tara Smith - LicenseeTIME COMPLETED:
01:31 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 11:38am, LPA met with licensee, Tara Smith. Also present during this inspection, is Licensee’s assistants. The licensee states that she currently has 10 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6:30am-6pm, Monday to Friday.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, family room (den), day care room (converted garage), and backyard (fenced). The children use the day care room, one bathroom in hallway, kitchen, dining room, living room, family room, and backyard. Per licensee, areas off limits to children and parents include: all bedrooms, bathroom in master bedroom, and part of backyard that is fenced off. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 3 adults and 1 minor currently live in the home. Persons living in the home are identified on the attached LIC811. Licensee states that she currently has two assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT


At 11:45am, LPA was lead on a tour of the facility by the licensee. Upon entry through a sliding glass door, you enter the small hallway nook used for breakfast. Directly to the right, you enter the day care room, which is a converted garage. There are age appropriate toys and equipment throughout the room and proper AC and ventilation. Per licensee, the children do not eat or nap in this room. There were cubbies and supplies available. At 11:50am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 05/03/2022, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.
REPORT CONTINUES PAGE 1 of 3
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198012661
VISIT DATE: 07/13/2022
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There are first aid supplies available. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted by doorway. The tour continued to the backyard which is currently used as an outdoor play space. LPA observed it to be fenced. There were tables for meal time, bikes, a small play tunnel, a small play house, and a small play structure present for children in care. LPA was led through the kitchen, which children talk through. There are child safety locks on the cabinets and drawers where sharp knives are. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The kitchen leads to the dining room and living room. The family room is adjacent to the dining room. These rooms are only used for nap time. LPA observed cots to be laid out during the tour.

Per licensee, the living room will be used as an area for an ill child until an authorized representative comes to pick up child. Smoke and carbon monoxide detectors were tested and are operable. Fireplaces and open face heaters are inaccessible to prevent access by children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The licensee states that there is a land line on the premises. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 07/2023. Licensee and other personnel have complete mandated reporter training that expires on 05/2024. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

Infant Care: Licensee states that they are 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. Licensee states that infants sleep in the family room (den) LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

REPORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198012661
VISIT DATE: 07/13/2022
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The following was discussed: -Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There are no pets on the premises.
-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 license family child care home.

Incidental Medical Services (IMS):


The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

COVID Health and Safety protocols were observed and discussed with the Licensee.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

Exit interview conducted with Licensee Tara Smith at 1:13pm, copy of report provided.


END OF REPORT PAGE 3 of 3
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3