073409382-2-2-2023-02-CC-CACA-CNP2L6-20230202162902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409382
Report Date: 02/02/2023
Date Signed: 02/02/2023 04:29:13 PM

Document Has Been Signed on 02/02/2023 04:29 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, ALISA		FACILITY NUMBER:	073409382
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	02/02/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Alisa Smith		TIME COMPLETED:	04:40 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	Licensing Program Analyst (LPA) Cherie Acosta met with applicant for an announced prelicensing/change of location inspection. Present during the inspection was the applicant, her daughter-in-law, Vanessa Williams and friend Kathy Nord. There were 6 children present during the inspection. 5 of the children present are the licensee's grandchildren. Applicant was caring for one child that was not related to her. Applicant states that the hours of operation will be 4:30am to 7:00pm Monday through Friday. Appliacnt stated that times will vary. The home was toured for a Health and Safety Inspection. The home is two story home. The first level of the home consist of the living room/day-care area, formal dining room/day-care area, bedroom/office, bathroom, family room, master bedroom, master bathroom, laundry room, coffee/dry bar area, garage, kitchen and dining area. The second floor consist of two bedrooms, one bathroom and loft. The home is neat and clean with heating and ventilation for safety and comfort. The on limits area that will be used for child care include the living room/day-care area, formal dining room/day-care area, bathroom located near the day-care area, family room, kitchen and dining area. The remainder of the home is off limits to children in care. Off limits areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision The Isolation Area will be the formal dining room/day-care area. The fenced backyard will be used for outdoor play. There are age appropriate toys in the home. There are no pools, hot tubs or any other similar bodies of water at this home. There are no firearms in the home as stated by the applicant. LPA did not observe any hazardous materials or toxins accessible to children today. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 3A40BC fire extinguisher. The fireplace is screened to prevent access by children. Stairs are gated.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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, ALISA	FACILITY NUMBER: 073409382
	VISIT DATE: 02/02/2023

NARRATIVE

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The applicant has current CPR/First Aid which expires 09/23. Applicant completed mandated reporter training 4/12/22. Applicant is in compliance with required immunizations. A copy of the lease was reviewed and shows control of property.

LPA discussed the safe sleep regulations with applicant 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 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

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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, ALISA	FACILITY NUMBER: 073409382
	VISIT DATE: 02/02/2023

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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

Prior to licensure applicant shall provide proof of completing the required lead poisoning prevention training.

Exit interview and report was reviewed with Alisa Smith.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

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