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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313174
Report Date: 10/17/2019
Date Signed: 10/17/2019 01:52:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SMITH, TAMARAFACILITY NUMBER:
304313174
ADMINISTRATOR:SMITH, TAMARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 619-2365
CITY:IRVINESTATE: CAZIP CODE:
92602
CAPACITY:14CENSUS: 11DATE:
10/17/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tamara SmithTIME COMPLETED:
02:30 PM
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A Plan of Correction inspection was conducted by LPA Valencia in response to an A violation cited during an annual inspection conducted on 10/9/19. During the inspection on 10/9, an A violation was cited for ratio, as there where 5 infants in care out of the total 12 children. During today's inspection it was observed that there were 11 children in care, 4 of which are infants, with an adult assistant present assisting with care.. The facility has corrected its A violation and is in compliance as of today's POC inspection. The facility understands it must remain within compliance of ratio regulations of a large FCCH and may not ever have more than 4 infants (under 2 years old) in care.

The licensee was given a Notice of Site Visit, and advised this must be posted for 30 days.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
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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