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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607983
Report Date: 03/22/2023
Date Signed: 03/22/2023 04:01:00 PM


Document Has Been Signed on 03/22/2023 04:01 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:SMITH, GLORIAFACILITY NUMBER:
393607983
ADMINISTRATOR:SMITH, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 298-5315
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 5DATE:
03/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Gloria SmithTIME COMPLETED:
04:15 PM
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On March 22nd, 2022, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Gloria Smith for the purpose of an annual inspection. Facility hours of operation are seven days a week 24 hours a day. Licensee was advised not to exceed 24 hours of consecutive care. All adults living and working in the home have criminal record on file with the Department. Licensee stated that no new residents moved into the home since licensure. Capacity specified on the license was met on today’s inspection. Present in the facility were 5 daycare children.

A health and safety inspection was conducted in all areas accessible to children. Off limit areas are: All bedrooms, Garage and Backyard. Licensee was reminded that day care children may never enter these off-limit areas. LPA advised that Licensee must notify Licensing prior to any addition or new construction to the home as well as any changes to the off limits or on limits daycare areas. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan and Notification of Parents Rights. LPA provided Earthquake Preparedness Checklist and updated forms to keep in children’s files. Home is clean and appropriately ventilated. Age-appropriate toys and reading material were observed. There were no hazardous materials or chemicals observed accessible to children. Medications are inaccessible to children. Licensee stated there are no weapons in the home. No bodies of water were observed on the premises and the backyard is kept off limits to the daycare children. Facility maintains a working phone, 2A10BC fire extinguisher, and functioning smoke/carbon monoxide detector.

5 Children files were reviewed and the files contain all the required forms and information. Current in person EMSA CPR and First Aid certification was verified and expires on 08/13/24 and AB 1207 Mandated Reporter Training was verified and expires 10/18/24. LPA observed a current roster and fire drills are conducted at least once every six months and are properly log. Last fire drill was conducted on 02/03/23.

Report continues on subsequent page 809C--
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: SMITH, GLORIA
FACILITY NUMBER: 393607983
VISIT DATE: 03/22/2023
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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.

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
LPA discussed the safe sleep regulations and discussed the Child Care Licensing 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.

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
This report and Appeal of Rights were provided and reviewed with Licensee, Gloria smith. Exit interview conducted and Notice of site Visit was posted.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC809 (FAS) - (06/04)
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