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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019823
Report Date: 05/15/2023
Date Signed: 05/15/2023 04:42:41 PM


Document Has Been Signed on 05/15/2023 04:42 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
198019823
ADMINISTRATOR:SHERIAH R. SMITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 988-8262
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 4DATE:
05/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Sheriah Smith, LicenseeTIME COMPLETED:
05:05 PM
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Licensing Program Analyst (LPA) Susann Sanchez and Denise Gibbs conducted a Plan of Correction (POC) inspection on this date. LPA met with Licensee, assistant Joyce George and gave LPAs a tour. Licensee Sheriah Smith arrived at 4:20pm. The purpose of the POC inspection was determine if Licensee has corrected the deficiency cited on 48/20/2023. LPA determined the following:
  • LPAs observed 3 infants and 1 school aged child.
  • LPA reviewed 4 children's files and observed LIC 9224 (Acknowledgment of Receipt) in children's files.
  • LPA observed Notice of Site visit & 809 report from 04/20/2023 posted in the hallway.
  • Licensee submitted children schedule on 04/21/23.

Therefore, based on LPAs records review and observations, POC has been cleared.

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.

Exit interview was conducted with Licensee Sheriah Smith, but not limited to Provider Rights, Appeal Rights were given in and explained.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
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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