198019823-11-26-2019-54-CC-RJOS-BJB2DP-20191126161840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019823
Report Date: 11/26/2019
Date Signed: 11/26/2019 04:18:53 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 CARE		FACILITY NUMBER:	198019823
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	11/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Sheriah Smith, Licensee		TIME COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On November 26, 2019 at 1:40p.m. Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted an unannounced annual random inspection at the facility listed above. LPA met with Licensee Sherlinda Franklin and Licensee Assistant Michelle Guerrero who guided analyst on a tour of the facility. Upon arrival were the Licensee, Assistant and four sleeping infants. Licensee Sheriah Smith arrived at 2:00pm. Per the Licensee, there are eight children currently enrolled. A current children’s roster was available for review. Current residents include two adults (Licensees) and Licensee 11 year old son. This is a one-story home which consists of three bedrooms, two bathrooms, kitchen, living room, enclosed patio, front yard and backyard (fenced). Children’s areas include the living room, rear bathroom, kitchen, front yard and backyard. The children use the bathroom located in the rear hallway. The restroom that children use was observed safe and sanitary. Per the Licensee, areas off limits to children and parents include: master bathroom and all bedrooms. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone which remains at the facility during operating hours. There is ventilation and heating (central). There is a child safety gate which keeps the kitchen and bedrooms inaccessible to children. There are appropriate toys available for children, free of sharp edges and unbroken. At 2:30p.m. LPA observed sleeping equipment including cots with blankets, four Pack-n-Plays(Foundation and Delta) and two standard cribs. Licensee states she is currently caring for infants ONLY. Licensee states that infants sleep in the den/children's area. Licensee was advised that pending future regulations will require infants to sleep in a standard crib only, where they are constantly supervised. LPA discussed with Licensee the Child Care

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko Jones	TELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 198019823
	VISIT DATE: 11/26/2019

NARRATIVE

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Provider’s Guide to Safe Sleep to reduce the risk of SUID by the American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby and Safe Sleeping practices.

The kitchen was observed safe and sanitary. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed inaccessible to 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 valve on the required 2A 10BC fire extinguisher indicated fully charged and serviced July 2019 as indicated on service tag. Smoke and carbon monoxide detectors were tested and operable.

Licensee states that there are no firearms stored in the home. The licensee provides all food for children in care.

Currently, children use the back yard for outdoor play time. The outdoor play area was observed fenced. LPA observed appropriate toys and equipment used for children as well as a locked storage shed. LPA did not observe any objects that can pose a danger to children in the outdoor yard. The Licensee states that supervision is always provided.

The Licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The Licensees Pediatric First Aid and CPR expires on May 2020. There are first aid supplies available.

Children’s records were reviewed and observed complete.

The Licensee and her Assistant provided proof of immunization against influenza, pertussis, and measles.
LPA observed proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file for Licensee, however no certificate was on file for Licensee Assistant.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. LPA observed last drill completed on November 7, 2019.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko Jones	TELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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: 198019823
	VISIT DATE: 11/26/2019

NARRATIVE

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There are no pets on the premises.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed and posted.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.
Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA advised the Licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

PRE_LICENSING_CAPACITY INCREASE
LPA inspected facility for a capacity increase. LPA reviewed Licensee Assistant immunizations however no mandated reporter certificate was available. Licensee will not be authorized for a capacity increase until the required documents are received.

Assistant Requirements:
1)Proof of TB clearance (within one year); 2) Notice of Employee Rights (LIC 9052); 3) Criminal Record Statement (LIC 508); 4) Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9108), 5) Mandated Child Abuse Reporter Training Certificate, 6) Required immunization's MMR, Influenza and Pertussis.

The licensee must correct the deficiencies which were issued today before a capacity increase may be issued. The corrections are due by 12/3/19.

Based on the LPA’s 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 must be cleared to protect the children’s health & safety.

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko Jones	TELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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: 198019823
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/26/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/03/2019 Section Cited	1 2 3 4 5 6 7	Mandated Reporter Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion.
	8 9 10 11 12 13 14	The requirement was not met as evidenced by: LPA did not observe certificate for Licensee Assistant.	8 9 10 11 12 13 14
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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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko Jones	TELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

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