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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423930
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:53:08 PM

Document Has Been Signed on 02/23/2024 03:53 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SMITH, SHELLANN & CUMMINGS, LAKYSHAFACILITY NUMBER:
013423930
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Lakysha CummingsTIME COMPLETED:
03:50 PM
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On 02/23/2024, at 1:07 pm, Licensing Program Analyst (LPA) Ashley Akinleye conducted an announced prelicensing inspection. Present for the inspection was the Applicant, Lakysha Cummings. Residing in the home is both of the licensees. However, only one was present during today’s inspection. The home was toured for a health and safety inspection. Operating hours will be 7:00 am - 11:00 pm, seven days a week.

The house is apart of a duplex that is two story home and has a separate address. There are two bedrooms and one bathroom, which is neat and clean with heating and ventilation for the children. The entrance to the day care is the side of the home. The inside of the home were observed to be neat, clean with age-appropriate materials and toys for the children. Licensee has stated that there are no firearms in the home.

ON LIMIT AREAS: Two bedrooms, one bathroom, and kitchen.
OFF LIMIT AREAS: The garage and the entire backyard area, which will be inaccessible by closed and/or locked doors or visual supervision.
ISOLATION AREA: The kitchen will be used for an isolation area, away from children in care.

The home has a working smoke detector, a carbon monoxide detector and a working telephone. The Applicant was reminded of the responsibility as a mandated reporter and CPR/First Aid Requirements. LPA did not observe any bodies of water in or around the home. There are no pets on the property.

Report continues on 809C
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SMITH, SHELLANN & CUMMINGS, LAKYSHA
FACILITY NUMBER: 013423930
VISIT DATE: 02/23/2024
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 applicant and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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 22-02-CCP. 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



To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted with Lakysha Cummings. Appeal Rights were provided.

License is effective as of 2/23/2024.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC809 (FAS) - (06/04)
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