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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423011
Report Date: 07/07/2023
Date Signed: 07/07/2023 12:00:02 PM

Document Has Been Signed on 07/07/2023 12:00 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SMITH, RACHELFACILITY NUMBER:
013423011
ADMINISTRATOR:SMITH, RACHELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 799-6900
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
07/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rachel Smith TIME COMPLETED:
12:15 PM
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On 07/07/2023 at 10:00 AM Licensing Program Analyst (LPA) Diana Campos arrived at facility to conduct an unannounced Annual Required inspection at Rachel Smith Family Childcare Home. LPA met with licensee and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours of operation are Monday to Sunday 06:00 AM to 03:00 AM. Present in the home at time of inspection were Licensee and her minor daughter. Licensee's 2 minor sons also reside in the home but were not present during today's inspection. No children were in care during today's inspection.

Indoor Space: A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is a (one story house consisting of 2 bedrooms, 1 bathroom, living room/dining area, kitchen. The home is sanitized and orderly in compliance with Title 22 Regulations during today's inspection, with heating and ventilation for the safety and comfort of children in care. Outdoor Space: LPA toured the outdoor area (backyard) and observed it was fenced. LPA observed there are no pools, hot tubs or other bodies of water. There is a separate one bedroom unit behind the residence and licensee was reminded that 100% visual supervision will be required when children begin using the back yard. OFF-LIMIT areas are the first bedroom to the right of living room, the kitchen and the backyard. LPA observed these areas are inaccessible to children in care today by closed locked doors and visual supervision. IN-USE The living room/dining area, bathroom and the bedroom to the left of the bathroom are used as the primary areas for day-care.


Medicines, cleaning products, and sharp objects are stored inaccessible to children in care during today's inspection. The wall heater is screened, and the home maintains a working telephone. Licensee was reminded that smoking is not allowed in a family child care home. Licensee was reminded that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. There is one dog and one caged iguana in the home. Licensee stated there are no arms and ammunition stored in the home. There is a 3A40BC fire extinguisher, smoke and carbon monoxide detector in the home. Children files and Facility files were reviewed. Facility contained a Children's Roster, Licensee’s mandated reporter training expires 6/29/2025.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
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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Document Has Been Signed on 07/07/2023 12:00 PM - It Cannot Be Edited


Created By: Diana Campos On 07/07/2023 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SMITH, RACHEL
FACILITY NUMBER: 013423011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that licensee did not have current proof of CPR/first aid certificate available during today's inspectoion which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2023
Plan of Correction
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Licensee will submit to licensing by the POC date current proof of completion for CPR/First Aid training certificate.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Diana Campos
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023


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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SMITH, RACHEL
FACILITY NUMBER: 013423011
VISIT DATE: 07/07/2023
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was 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 5 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 discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22.

Exit interview conducted and report was reviewed with the licensee Rachel Smith.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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