198012661-7-11-2023-33-CC-NTCG-CTMU5L-20230711151655

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012661
Report Date: 07/11/2023
Date Signed: 07/11/2023 03:17:00 PM

Document Has Been Signed on 07/11/2023 03:17 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	SMITH FAMILY CHILD CARE		FACILITY NUMBER:	198012661
ADMINISTRATOR:	SMITH, TARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 351-5240
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	14	CENSUS: 11	DATE:	07/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Tara Smith - Licensee		TIME COMPLETED:	03:35 PM

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 1:55am, LPA met with licensee, Tara Smith. Also present during this inspection, is Licensee’s assistant. The licensee states that she currently has 12 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6:30am-6pm Monday-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 4 adults and 0 minor currently live in the home. Persons living in the home are identified on the attached LIC811. Licensee states that she currently has one 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 2:05pm, LPA was lead on a tour of the facility by the licensee. Upon entry into the home, LPA entered from the sliding door to the nook. There are small tables for children to sit and eat at. There is a converted garage immediately to the right. It is currently being used as the main activity room. There is an AC unit and age appropriate books, toys, and games. Per licensee, there is no eating or sleeping taking place in the converted garage. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted on the wall of the activity room. At 2:10pm, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 06/14/2023, 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 Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 198012661
	VISIT DATE: 07/11/2023

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There are emergency supplies and a first aid kit available. The tour continued back through the nook, through the kitchen, which is used as a walkway. Sharp knives are kept in the dishwasher, out of reach of children in care. The next room reviewed is the living room which is used as a nap area. During the time of the inspection, LPA observed children napping on cots. Per licensee, the living room will be used as an area for an ill child until an authorized representative comes to pick up child. There is a small attached room called the "Infant Space" where LPA observed pack n plays. The tour continued back through the living room to the hallway where there was a bathroom for children in care to use. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. Smoke and carbon monoxide detectors were tested and are operable. The licensee states that there is a land line on the premises but cell phone is used as main contact. 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 last area reviewed was the outdoor area back through the nook.

At 2:20pm, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There is shade for children in care. Age appropriate toys and equipment, such as playhouses and tunnels, were observed. 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 05/2025. Licensee and other personnel have completed mandated reporter training that expires 07/04/2025. 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.

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.

-PETS: There are no pets on the premises.
-PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, 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
REPORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 198012661
	VISIT DATE: 07/11/2023

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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 infant space. 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.

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.

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/

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

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.

Exit interview was conducted with Licensee Tara Smith, at 3:15pm. Copy of report provided.

END OF REPORT PAGE 3 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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