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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500286
Report Date: 09/25/2020
Date Signed: 09/25/2020 10:48:15 AM

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, KALIKAFACILITY NUMBER:
394500286
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
09/25/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kalika SmithTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Fabiola Diaz conducted a tele-inspection due to COVID-19 State of Emergency for the purpose of a change of location. The tele-inspection was conducted on FaceTime. Licensee Kalika Smith applied for a change of location for a small family child care home. Previously, licensee was licensed at different location with license number 393623038. The licensee’s own children were present during today’s tele-inspection.

The family child care home facility is a one story family home with 4 bedrooms, 2 bathrooms, a garage, laundry room, kitchen, dining area, living room, and a fenced backyard. Off limit areas: all bedrooms, laundry room, and garage. All off limits areas must be made inaccessible to children. Licensee stated she will provide transportation services for children in care. All individuals subject to criminal background review have obtained a criminal record clearance. The day care hours of operation are Monday through Friday 6 AM to 6:30 PM.

LPA tele-inspected the inside and outside of the home with the applicant for health and safety hazards. All the toxic or hazardous materials are inaccessible to children. LPA advised the licensee that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock. Licensee understands that if she will be using child safety cabinet locks, they must be checked regularly and functional. The house has a working telephone, fully charged wall mounted fire extinguisher, and a dual smoke and carbon monoxide detector that meet Title 22 regulations. There is a variety of age appropriate toys available. As per the licensee, there are no firearms or weapons in the home. There are no stairs or a fireplace in the facility. LPA observed the backyard to contain a trampoline and a swing-set, and licensee stated she will ensure they are maintained in operable and safe conditions for children in care. Licensee stated there will be adult supervision at all times when children are using the trampoline and swing-set. Licensee stated the swing-set will be anchored safely to the ground before being used by the children in care. Licensee stated that the manufacturer instructions and age-limit labels will be followed for the trampoline, swing-set, and toys.
Page 1. Report continues on LIC 809-C...
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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, KALIKA
FACILITY NUMBER: 394500286
VISIT DATE: 09/25/2020
NARRATIVE
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LPA discussed licensing regulations and capacity requirements. Licensing forms and posting requirements were reviewed with the licensee. Prior to the tele-inspection, LPA observed licensee’s proof of homeownership, CPR/First Aid Card that expires 01/19/21 and Mandated Reporter Certification expires 09/18/2022. LPA observed the record of licensee’s immunization on file. Licensee has completed the Lead Poisoning Prevention component course for the Preventative Health and Safety training on 9/17/2020. Licensee has the required postings in a conspicuous place. LPA informed the licensee that Fire Drills need to completed every six months.

Licensee was encouraged to maintain supervision at all times. LPA discussed requirements for staff, adult assistants, and adults living in the home. LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against, Pertussis, Measles and Influenza. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. Licensee understands that a current roster must be maintained. Licensee understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to licensee that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected. Licensee understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area. Licensee understands that children’s records are to be maintained according to Title 22 regulations, and be accessible to licensing for up to three years.

LPA discussed the inspection authority of the Department by authorized agent to enter and inspect the family child care home providing care, supervision and services at any time, with or without advance notice to secure compliance with the regulations in accordance with Section 102396. LPA discussed that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changes.The applicant is encouraged to frequently visit website at http://www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates. LPA e-mailed licensee the new Safe Sleep Regulations.


Page 2. Report continues on LIC 809-C...
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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, KALIKA
FACILITY NUMBER: 394500286
VISIT DATE: 09/25/2020
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LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the licensee that if any unusual incidents occur she must contact the Department within 24 hours and a UIR must be submitted with 7 days, describing the specifics to the incident.
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

As of today, 9/25/2020 the facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted. A copy of this report was e-mailed to the licensee to keep on file at the facility. A “read receipt” and/or an e-mail from applicant stating applicant has read this report is in lieu of a signature due to COVID-19. Applicant stated she will also sign the report and provide a copy to LPA.

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SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3