013423460-6-29-2023-02-CC-DCAS-CT9PCK-20230629111204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423460
Report Date: 06/29/2023
Date Signed: 06/29/2023 11:12:16 AM

Document Has Been Signed on 06/29/2023 11:12 AM - 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, LAKEISHA		FACILITY NUMBER:	013423460
ADMINISTRATOR:	SMITH, LAKEISHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 529-5671
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	06/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lakeisha Smith		TIME COMPLETED:	11:30 AM

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	On 6/29/2023 at 08:30 AM Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required inspection at Lakeisha 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 Friday 07:30 AM to 5:00 PM Present in the home at time of inspection were licensee, one fingerprint cleared assistant and 6 children in care consisting of one infant and five preschoolers. Indoor Space: At 9:35 A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 3A40BC fire extinguisher, smoke and carbon monoxide detector in the home. 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 OFF-LIMIT areas are the front and side yards and as of today both bedrooms to the left and right end of hallway will be placed off limits to day care children per licensee's request. Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. IN-USE The living room, the eat-in kitchen, hall bathroom, the converted garage, bathroom inside the converted garage, the backyard and side yard between house and garage is used as the primary areas for day-care. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with latches. LPA reminded licensee that smoking is not allowed in licensed day care homes. Licensee was also reminded that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are no pets and arms and ammunition stored in the home. The home maintains a working telephone.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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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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: 06/29/2023

NARRATIVE

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Outdoor Space: LPA toured the outdoor area (back and left side yard behind home) and observed it was fenced. LPA observed there are no pools, hot tubs or other bodies of water.
Children files and Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training expired 6/27/2023 Licensee's CPR/First Aid expired 6/12/2023 and licensee states she will be registering for class today.
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.

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

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 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.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. 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: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/29/2023 11:12 AM - It Cannot Be Edited

Created By: Diana Campos On 06/29/2023 at 10:47 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, LAKEISHA	FACILITY NUMBER: 013423460
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/29/2023

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that licensee's CPR/First Aid certificate expired on 6/12/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/28/2023
	Plan of Correction
1 2 3 4	Licensee will submit to licensing by POC date proof of enrollment as soon as completed and proof of completion certificate once available.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC809 (FAS) - (06/04)

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