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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018224
Report Date: 06/13/2022
Date Signed: 06/13/2022 01:08:20 PM


Document Has Been Signed on 06/13/2022 01:08 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:
198018224
ADMINISTRATOR:SMITH, HARRIETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 756-3332
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY:14CENSUS: 0DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Harriet Smith, LicenseeTIME COMPLETED:
01:25 PM
NARRATIVE
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At 8:35 am Licensing Program Analyst (LPA) Lilli Babcock conducted an unannounced required 1-year inspection to the above facility. A COVID risk assessment was conducted upon entry and appropriate PPE was used. LPA met with Licensee, Harriet Smith, to whom the reason for the visit was explained. Per Licensee, there are 16 children currently enrolled. There were no children present upon arrival. The licensee was observed to be operating within the license capacity limitations.

The licensee states that 2 adults and no children currently live in the home. All adults living in the home have obtained a criminal record clearance.

This is a one-story home which consists of living room, dining room, family room (fireplace has a cover), dining nook, kitchen, pantry/laundry room, 3 bedrooms, 3 bathrooms, back patio, front yard, backyard and detached garage which includes a bedroom and no bathroom. Tenant living in detached garage is fingerprint cleared and associated.

Childcare will take place in the dining room, family room, dining nook, kitchen, pantry/laundry room, 1 bathroom, and back patio. These areas were inspected for safety, comfort, and cleanliness. LPA observed 3 outlets that were missing the childproof covers. LPA also advised licensee to put childproof doorknob covers on the inaccessible doorknobs to keep rooms inaccessible.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2022
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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Document Has Been Signed on 06/13/2022 01:08 PM - It Cannot Be Edited

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: 198018224

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the safe sleep log section cited above in 3 out of 3 childrens files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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Licensee states she will begin using the sleep log immediately. Licensee will email the sleep log to LPA after an entry is made and continue using the sleep log with all infants, new and existing, in care.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 3 out of 3 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2022
Plan of Correction
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Licensee and Staff #2 and Staff #3 will complete Mandated Reporter Training and email Certificates to LPA

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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/13/2022 01:08 PM - It Cannot Be Edited

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: 198018224

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 3 out of 3 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2022
Plan of Correction
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Licensee will provide proof of pertussis, measles and flu immunizations for herself, staff #2 and staff #3 to LPA via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198018224
VISIT DATE: 06/13/2022
NARRATIVE
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Per licensee, areas off limits to children and parents include 3 bedrooms, 2 bathrooms, living room, backyard area apart from the patio, detached garage/bedroom, and front yard.

Licensee guided analyst on a tour of the facility at 8:45 am. During this visit, all areas identified on the facility sketch that are accessible for children to use were toured and inspected and the following was observed.

Facility License, Emergency Disaster Plan, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted in the entry way of the home. A current children’s roster was available for review.

There is telephone service via a landline and cellphone. Hours of operation are Monday – Friday, 7:00 am – 7:30 pm. There is central air and heating in the home. LPA observed a fireplace in the living room has a screen and is gas operated. The key to turn on the gas fireplace is inaccessible to children.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee there are no poisons in the home. Licensee states that there are no firearms or weapons stored in the home.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 5/27/22, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

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 5/27/22.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198018224
VISIT DATE: 06/13/2022
NARRATIVE
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The home is observed to be clean and orderly. There are first aid supplies available. There are age-appropriate toys available for children. Appropriate sleeping arrangements in form of a playpen were observed.

Licensee states that she is currently caring for three infants. Licensee does not care for the infants during the same days/hours. At 9:43 am, licensee stated she does not know about the sleep log regulations and does not currently use a sleep log or fill out the LIC 9227. LPA consulted with licensee regarding the Safe Sleep Regulations and provided a sample log.

Currently, children are using the back patio for outdoor play time. The back patio has covered shading and ceiling fans. There is a gate fence, with a lock, and concrete wall that prevents children from going to the grass backyard area; the grass backyard area and detached garage are off-limits. Outdoor play area was inspected for safety. There is a built-in barbecue pit which can only be turned on with a key; key will be inaccessible to children in care. LPA observed that the outdoor yard has toys and other materials for children to play with. No bodies of water were observed on this day.

At 10:00 am children’s records were reviewed, including emergency information and were observed to be complete with the exception of signatures on the LIC 700 for Child #1 and Child #9.

At 10:30 am Licensee and staff records were reviewed, and LPA observed that Licensee and staff #2 and staff #3 have not completed Mandated Reporter Training. Licensee stated she does not have Preventative Health and Safety Training and none were noted or observed in the facility file.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC809 (FAS) - (06/04)
Page: 6 of 13
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: 198018224
VISIT DATE: 06/13/2022
NARRATIVE
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The licensee's Pediatric First Aid and CPR expires on 8/6/22. Licensee is missing proof of measles and flu vaccine; Staff #2 is missing flu vaccine; Staff #3 is missing Pertussis, Measles and Flu vaccine. Staff #2 and Staff #3 are missing LIC 508, LIC 9052, and LIC 9108.

LPA issued an LIC 857, Children’s Record Review, and LIC 859, Staff Record Review to the licensee which documents staff and children’s files reviewed during this inspection.

There are 3 dogs and 2 cats on the premises. Per licensee, the dogs are kept outside in off-limits areas during daycare hours.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, trampolines, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family childcare facility.

LPA also informed licensee Harriet Smith of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198018224
VISIT DATE: 06/13/2022
NARRATIVE
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101226. When any IMS is provided, an updated Plan of Operation that includes 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198018224
VISIT DATE: 06/13/2022
NARRATIVE
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Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Based on the LPAs observations and records review, the following deficiencies listed on the attached LIC 809D (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 and safety.



Exit interview conducted and report was reviewed with the licensee Harriet Smith.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC809 (FAS) - (06/04)
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