364815886-1-30-2025-09-CC-ALAA-DDEVA2-20250130151514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364815886
Report Date: 01/30/2025
Date Signed: 01/30/2025 03:15:22 PM

Document Has Been Signed on 01/30/2025 03:15 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	SMITH FAMILY CHILD CARE		FACILITY NUMBER:	364815886
ADMINISTRATOR/ DIRECTOR:	SMITH, CAMARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 466-7889
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91701
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 9	DATE:	01/30/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Camara Smith		TIME VISIT/ INSPECTION COMPLETED:	03:35 PM

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On the date and time listed, Licensing Program Analyst (LPA) Aman Lama arrived at the facility to conduct an annual inspection. Upon arrival, LPA was met with licensees assistant, who granted LPA access to the home. Licensee, Camara Smith swapped with assistant to greet LPA. LPA then toured the on-limits indoor and outdoor areas of the facility.

Normal days and hours of operation are listed as: Monday-Friday, 7:00am-5:30pm.

OFF-LIMIT AREAS ARE LISTED AS FOLLOWS: Master Bedroom, Room 2, Bathroom 2 and Garage.

· A working telephone is present and current phone number is on file.

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were all in working order.

· LPA observed hazards inaccessible to daycare child(ren).

· No guns/weapons currently kept in the home. All guns, weapons and ammunition must be key locked separately, made inaccessible, and must remain in compliance with Title 22 Regulations.

· Licensee had appropriate postings posted near the entrance of the home.

· Mandated Reporter Training certificate for licensee and assistant were updated.

· Pediatric CPR and First Aid Card for licensee has been updated and expires on: 02-24-2025.

· Health & Safety Certificate for licensee has been completed and is on file.

· LPA observed Clean, safe and age appropriate toys available for children.

· Documentation of last fire/disaster drill was available. Last drill conducted: 01-06-25.

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 364815886
	VISIT DATE: 01/30/2025

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·Bodies of water were not observed on the property during today’s inspection. Licensee is reminded that all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly fenced per Title 22 Regulations. The Department must be notified before and after installation of any of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

-LPA reminded licensee of the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage as an additional resource at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

-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.

-Licensee is not currently administering medications. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 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

- The 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.

- To receive Provider Information Notices (PINs), go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the “Quick Links”. You can add your email address and choose which program(s) to receive PINs for.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 364815886
	VISIT DATE: 01/30/2025

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- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200.

The licensee, Camara Smith, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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

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

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

LIC809 (FAS) - (06/04)

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