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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423460
Report Date: 10/13/2021
Date Signed: 10/13/2021 02:53:38 PM

Document Has Been Signed on 10/13/2021 02:53 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, LAKEISHAFACILITY NUMBER:
013423460
ADMINISTRATOR:SMITH, LAKEISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 529-5671
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
10/13/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lakeisha SmithTIME COMPLETED:
03:30 PM
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On 10/13/2021 at 1:00pm approximately, Licensing Program Analyst (LPA) Diana Campos conducted an in-person case management inspection to add a converted garage as additional activity/play space to the day care. Present during today's inspection were licensee, and one preschool age child in care. The entire home was toured to conduct a health and safety inspection with licensee. Hours of operation for day care are (Monday through Friday, 7:30am to 5:30pm.

This is a one story home which consists of living room, kitchen/dining area, two bedrooms, one bathroom, detached garage which has been converted as a classroom/activity room for the day care, one bathroom in the converted garage, backyard and front and side yards. The entire home is on limits. The front and side yards are off limits to day care children. Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. The fenced backyard will be used as the outdoor play area. There are age appropriate toys in the home. There are no firearms in the home as stated by the licensee. Licensee has one large dog that stays in the front and side yard area. LPA did not observe any hazardous materials or toxins accessible to children today.

The home has a fully charged 2 A 10 BC fire extinguisher. The home is equipped with working smoke detectors and carbon monoxide detector. There is a working telephone in the home. The applicant’s CPR and First Aid certificate is current and expires 06/12/2023. Licensee completed mandated reporter training 9/2020. Licensee is in compliance with immunization requirements. Safe sleep information was discussed with the licensee. Safety precaution in regards to COVID-19 were discussed and posters were posted on front door.
See 809-C for continuance.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SMITH, LAKEISHA
FACILITY NUMBER: 013423460
VISIT DATE: 10/13/2021
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The following items must be corrected/completed before approval of the converted garage can be granted:
-A recent copy of the approved fire clearance indicating if which parts of garage may be used for day care (including bathroom)
-repair baseboard in the garage bathroom.

Incidental Medical Services (IMS) policy was discussed. 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

No deficiencies observed at this visit.

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

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

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

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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