393616027-8-9-2023-53-CC-TDIP-CUJVS4-20230809164054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393616027
Report Date: 08/09/2023
Date Signed: 08/09/2023 04:41:07 PM

Document Has Been Signed on 08/09/2023 04:41 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SMITH, TINA & ERVIN		FACILITY NUMBER:	393616027
ADMINISTRATOR:	TINA & ERVIN SMITH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 239-3329
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	14	CENSUS: 6	DATE:	08/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Tina Smith		TIME COMPLETED:	04:45 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 08/09/2023 at 2:15 PM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensees Tina and Ervin Smith for the purpose of an unannounced annual inspection, and Licensees guided LPA on a tour of the home. Licensees provided proof of control of property. LPA observed six children present in the home with Licensees and their assistant. Licensees’ operating hours are Monday through Friday from 6:00 AM to 6:00 PM. LPA verified that annual fees are current. A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. The off-limits areas in the home include the laundry room, garage, and the entire second floor. LPA observed stairs to the second floor barricaded by a baby gate. LPA observed the required postings and a working phone. LPA observed a 3A40BC fire extinguisher meets regulations and verified dual smoke and carbon monoxide detectors were functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed a restroom and verified that toxic and hazardous items were inaccessible to children in care. LPA observed cleaners stored in the laundry room and inaccessible to children in care. LPA observed the living room with age-appropriate toys for children. Licensees stated there are no weapons in the home. LPA observed a fireplace that was barricaded by furniture. The outdoor play area was inspected and is surrounded by a wooden fence. LPA walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. The backyard has an in-ground pool area that is fenced according to Title 22 Regulations, and LPA observed the gate to self-close and self-latch. Continues on 809-C

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SMITH, TINA & ERVIN	FACILITY NUMBER: 393616027
	VISIT DATE: 08/09/2023

NARRATIVE

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Continued from 809 (Page 2)

All individuals subject to a criminal record review have obtained a criminal record clearance. Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reviewed five children's files, and LPA observed emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. LPA verified Licensees’ immunization records were available in the facility file. Current Mandated Reporter Training certificate was verified and expires on 01/06/2024. Current EMSA pediatric CPR and first aid certification was verified and expires on 01/28/2024.

LPA discussed the safe sleep regulations with Licensees 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 Licensees 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. LPA observed 15-minute napping logs for infants under 24 months and a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months during the inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at https://www.ada.gov/resources/child-care-centers/.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SMITH, TINA & ERVIN	FACILITY NUMBER: 393616027
	VISIT DATE: 08/09/2023

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Continued from 809-C (Page 3)

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensees were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There were no deficiencies cited at this time. An exit interview was conducted and report was reviewed with the licensees, Tina and Ervin Smith. During the exit interview, Licensees confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensees and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC809 (FAS) - (06/04)

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