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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500286
Report Date: 02/11/2021
Date Signed: 02/11/2021 02:23:37 PM

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: 2DATE:
02/11/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kalika SmithTIME COMPLETED:
01:45 PM
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On February 11, 2021 at 1:00 PM, Licensing Program Analyst (LPA), Fabiola Diaz met with Licensee, Kalika Smith via FaceTime video conferencing due to the COVID-19 pandemic for the purpose of an increase of capacity inspection. Licensee applied to change from a Small Family Child Care Home to a Large Family Child Care Home. LPA observed 2 day care children present in the home.

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, master bathroom, laundry room, and garage. Licensee acknowledged that children may never enter the off-limit areas. Licensee acknowledged that if she would like to change an off-limits area to on-limits, she will inform LPA for inspection and approval prior to using the space. Licensee stated there are no new residents in the home since licensure. All adult residents have criminal record clearances.

During the FaceTime inspection, LPA requested a tour of the facility. LPA and Licensee conducted a health and safety tour inside and out the home. Functioning smoke and carbon monoxide detectors and 2A10BC fire extinguisher were observed in the home. The Fire Safety Inspection Clearance has been cleared by Stockton Fire Prevention as of 02/09/2021.

The backyard is fenced and gated. LPA observed the backyard to contain a trampoline, a swing-set and toys. Licensee stated there will be adult supervision at all times when children are using the trampoline and swing-set. LPA and Licensee discussed the importance of following manufacturer instructions and age-limit labels for the trampoline, swing-set, and toys. Licensee stated there will be some work done with the backyard during the weekends, and licensee will ensure that hazardous items are no accessible to children in care. Licensee stated the backyard will maintain safe at all times for children in care.



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

DATE: 02/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021
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, KALIKA
FACILITY NUMBER: 394500286
VISIT DATE: 02/11/2021
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LPA observed that there were no hazardous items accessible to children inside and outside the home. Licensee stated that she understands that any poisons must be kept under lock and key. LPA observed that cleaning materials were inaccessible. Licensee stated there are no weapons in the home.

This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. Licensee was previously provided with the new Safe Sleep Regulations.

Effective today 02/11/21, facility is approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for small family childcare home.

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 licensee stating licensee has read this report is in lieu of a signature due to COVID-19. Licensee may also sign the report and provide a copy to LPA if able to do so.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021
LIC809 (FAS) - (06/04)
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