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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313989
Report Date: 09/01/2023
Date Signed: 09/01/2023 11:26:54 AM

Document Has Been Signed on 09/01/2023 11:26 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SMITH, GABRIELLEFACILITY NUMBER:
304313989
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 11CENSUS: 6DATE:
09/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gabrielle Smith TIME COMPLETED:
11:45 AM
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Licensing Program Analyst LPA's Karen Navar and Vivian Trinh conducted an unannouced case management inspection for the purpose of increasing capacity. The licensee is currently licensed for a small family childcare home for a capacity of 8 children. The licensee has requested to operate as large family childcare home for a capacity of 14 children. LPA met with licensee, Gabrielle Smith and toured the facility. 1 assistant was present and engaged with children. There was a total of 6 children present 5 of them were preschool age and1 child was and infant. 3 of those children were licensee’s own children. A review of criminal clearance records on this date indicates adults who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are (3) adult residents besides the licensee living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. She was reminded if changes to notify the licensing office. Licensee is Pediatric CPR and FIrst Aid ceritified that is EMSA apporved and is valid until 1/2025.

The facility is a one-story house with four bedrooms and two bathrooms. The licensee has designated the living room, dining room, backyard, and the bathroom located in the hallway for day care children's use. There’s a gate that separates living room and dining room that licensee stated she uses when needed during business hours. Living room has a fireplace that has been made in accessible to children by a protective screen. Garage door located by front door has been made in accessible to children by child safety lock on door handle. Backyard is fenced and gate entry to backyard is on side of house has that is locked. Second entrance to garage is through a door on side of house in the backyard has a child safety lock on door handle. Back yard has stairs leading up to a hill that has been made inaccessible to children by a lattice fence and strapped with bungee cords to stair rails. Cabinet in backyard has cleaning products in it that has been made inaccessible to children by a child safety lock. There is a spa located in the front of the sliding glass door in the backyard. The spa is locked with a hard top cover and has 4 locks on each corner that can only be locked and unlocked with a key. Licensee stated she will not use spa during business hours Lpa observed that spa was empty and licensee showed how cover is locked and unlocked at the four corners.
Cont. Page 2
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SMITH, GABRIELLE
FACILITY NUMBER: 304313989
VISIT DATE: 09/01/2023
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The licensee has designated the 4 bedrooms (master bedroom has bathroom) and kitchen as off limits. Licensee has off limit’s areas in accessible to children by door locks and safety latches, and child safe door knobs. The licensee has a cell phone to use for childcare LPA informed licensee that it must remain on the premises at all times during hours of operation. Gabrielle was informed and understands the home is to be free from smoking during hours of operation. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen are all inaccessible by means of safety locks. Poisons/Hazardous items are not stored on site, and none were observed.
Licensee has one dog and two chickens Licensee stated dog is up to date with immunization.

LPA reviewed Unusual Incident Report (UIR) form (LIC 624B)-advised to contact Licensing Officer of the Day within 24 hours and complete the UIR within seven days by faxing LIC624B to (714)703-2831. LPA advised applicant to report to licensing any unusual incident or child absence that threatens the physical or emotional health or safety of any child or any changes to hours and days of operation and also for any changes to facility, including on/off limit areas and change in phone number.

LPA reviewed with licensee requirements of Disaster Preparedness drills (documented every 6 months). The LPA advised of Affidavit Regarding Liability Insurance (LIC 282) if did not purchase liability insurance and to maintain the form in the children's files, and Car Safety Seat pamphlet were discussed and provided to the applicant. Posting requirements which include but not limited to Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9141), Parents Rights (PUB 394), Notice of Site Visit (LIC 9213), and License (LIC 203). LPA reviewed with applicant the need to maintain records including but not limited to Children records and Staff/Adults records, (LIC 311D).

The licensee has completed the Mandated Reporter Training for self and expires 02.2024. Department web site form was given to download forms, Title 22 regulations, and trainings on-line at http://www.ccld.ca.gov. The licensee has registered to obtain quarterly updates and notifications from the Department. Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. was provided. LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment. A copy of “A Child Care Providers Guild to Safe Sleep” was provided to applicant: English:

Cont. Page 3

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SMITH, GABRIELLE
FACILITY NUMBER: 304313989
VISIT DATE: 09/01/2023
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https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspxNIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

LPA reviewed with applicant the following safe sleep best practices:


· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chapter Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdfAppeal Rights and the appeal rights process was discussed with the applicant. The applicant was informed all appeals must be in writing and received by the licensing office within 15 business days.

An exit interview conducted where the report was reviewed with the applicant. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

The facility was in compliance for a Small Family Child Care Home with Title 22 Regulations at the time of inspection. An updated license for a large family childcare home is issued today.

The operation hours is from Tuesday through Friday 8:45am-3:30pm for ages 2-6 yrs old.

This report ends here.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC809 (FAS) - (06/04)
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