426216206-10-25-2021-17-CC-GRES-C85S4A-20211025133223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216206
Report Date: 10/25/2021
Date Signed: 10/25/2021 01:32:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	SMITH FAMILY CHILD CARE		FACILITY NUMBER:	426216206
ADMINISTRATOR:	MELISSA SMITH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 268-8500
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	14	CENSUS: 0	DATE:	10/25/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	Melissa Smith		TIME COMPLETED:	01:35 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	This is a Change of Location, previous License no. was 426215693 On 10/25/2021 at 12:46 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre Licensing inspection and met with applicant, Melissa Smith LPA asked applicant of pre- screening questions related to COVID-19, Applicant's responses suggest no COVID-19 exposure on site. LPA met with applicant and discussed the purpose of the Inspection LPA conducted the inspection of the interior and exterior of the home. During this tour the following was noted: Applicant applied for change of location on 10/15/2021. Per Applicant, the operating hours will be Monday through Friday from 6:30 AM to 4:30 PM. Applicant states she wants to care for children from 9 months old to 12 years of age. All areas identified on the facility sketch were inspected. Home is a two story home composed of 3 bedrooms and 2 and 1/2 bathrooms. Living room/day care area, family room, kitchen and 1/2 bathroom are accessible to day care children. LPA observed the the baby gate at the bottom of the stair case making the upstairs inaccessible to children. Three bedrooms upstairs are not accessible to children. The patio outside is not fenced. Visual and physical supervision is required when children are outside. Applicant stated day care children will use the nearby park for outdoor activities. LPA did not observe any bodies of water. Continued on LIC 809 C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 426216206
	VISIT DATE: 10/25/2021

NARRATIVE

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At 12:28 PM smoke detector and carbon monoxide detector were tested and were functioning at the time of the visit. Per Applicant, there are no guns nor ammunition in the home.

First Aid and emergency kits are available. The Applicant's First Aid and CPR expires 1/10/2022 Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles. LPA discussed Safe Sleep Regulations with Applicant.

Applicant is not providing Incidental Medical Services (IMS). 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.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Control of Property was reviewed. Fire Safety Inspection Clearance was granted on 10/22/2021.

License for Lare Family Child Care Home is granted effective 10/25/2021.

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. Exit interview was conducted with Melissa Smith .
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021

LIC809 (FAS) - (06/04)

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