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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700285
Report Date: 07/13/2026
Date Signed: 07/13/2026 03:07:00 PM

Document Has Been Signed on 07/13/2026 03:07 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
367700285
ADMINISTRATOR/
DIRECTOR:		PEGGY SMITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 252-6259
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
07/13/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Peggy Smith - LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On Monday July 13, 2026, at 1:20 PM, Licensing Program Analyst (LPA) Giovanni Cristales met with licensee Peggy Smith who guided the analyst on a facility tour. The purpose of the inspection is to conduct an unannounced Annual/Random Inspection. Licensee is licensed to provide care and supervision for a Large Family Child Care for a capacity of up to 14 children. LPA toured the areas of the home utilized for the Family Child Care to ensure the home follows Community Care Licensing Title 22 Regulations. Present during the time of this inspection were Licensee, licensee’s spouse, assistant, and 6 children in care. Family members residing in the home include two adults (Licensee and licensee spouse) and no minor children. All adults residing in the home have a Criminal Record Clearance. Days/hours of operation are Monday through Saturday, 23 hours.

Physical Plant: This is a single story 3-bedroom, 2-bathroom home with living room, office, kitchen, dining, laundry room, garage, front and back yard. The areas designated for childcare include the living room, kitchen, 1 bedroom, office, 1 bathroom and the backyard. The play area is clear and clean of debris with safe and age-appropriate toys, play equipment, and materials. No baby bouncer’s saucer chairs or any recalled or prohibited toys or sleep/play equipment were observed on the premises.

Home is clean and orderly. The home was inspected inside and out for safety, comfort, cleanliness, telephone service (land-line and cell), central heating and ventilation, inaccessibility to poisons, and cleaning items inaccessible (in the laundry room), dish detergent Inaccessible, medicines in (off-limits bedroom), that can pose a danger to children. Home has central AC and heat and ceiling fans. The home is clean and orderly, safe and age-appropriate toys, play equipment, and materials, Fireplace (made inaccessible with glass

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 367700285
VISIT DATE: 07/13/2026
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screening) no baby bouncer’s saucer chairs or any recalled or prohibited toys or sleep/play equipment were observed on the premises. All windows are free of cracks, bugs, or debris. Per licensee when a child becomes ill, the isolation area is in the office room until the parent can pick up the child. Per licensee there are no pool, spas, or bodies of water on the premises.

Off – Limit Areas: Include master bedroom, bedroom #3, master bathroom, laundry, garage, and front yard.

Bathroom: Located at the end of the hallway was observed to be clean, with soap, toilet paper, functioning faucet sink, flushing toilet, shower/tub and there were no hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, and nail polish. Cabinets underneath sink was accessible. LPA did not observe any hazardous items.

Kitchen: Sharp items (knives in kitchen cabinet upper cabinet) are inaccessible, and the home has a clean fully stocked food refrigerator/freezer. No chemicals in the kitchen were observed to be accessible. Licensee serves Breakfast, lunch, dinner, and snacks.

Napping: Licensee provides appropriate napping equipment mats and playpen, enough for children to nap. LPA observed sleep log for infant child in care.

Outdoor: LPA toured and inspected the back yard. The yard is completed fence (brick). The backyard was observed to have age-appropriate playing equipment. Octagon climbing dome, Little Tikes go carts, toddler slide, tic-tac-toe structure, basketball court, and round swing. The yard consists of artificial turf, cement, and pockets of dirt for proper playing. LPA observed a large play structure (slide/swing) anchored to the ground. BBQ grill, and AC unit are made inaccessible.

Advisory/Other: Staff #1, CPR/First Aid, Expires: (6/14/2027). Mandated reporter, Expires: (2/13/2027). Electrical outlets (are inaccessible with plastic plugs). There are no window cords accessible to children (Up high). The smoke and carbon monoxide detectors are in operable condition. First Aid kit was observed with supplies readily available underneath bathroom sink. Fire extinguisher (2A10BC) underneath kitchen sink, fully charged with the needle in the green. Per licensee, there are no weapons in the premises, and nobody smokes in the home. Transportation provided when needed. Per licensee there are no pets.

LPA observed documents to be posted in a prominent, publicly accessible (License, PUB 394, Earthquake Preparedness, facility sketch, to be complete and current). Emergency Disaster Plan and verification of fire and earthquake drills (5/12/2026).

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 367700285
VISIT DATE: 07/13/2026
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The following was discussed with the Licensee:

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 platforms.

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.

Licensee was reminded that 100% supervision is required at all times to children in care; Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department unusualincidentreport@dss.ca.gov.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, inspect the facility. The Licensee shall permit the Department to inspect the family childcare home and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations, also enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed changes, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family childcare home.

Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The Licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 367700285
VISIT DATE: 07/13/2026
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Criminal Record Clearance - FCCH - Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Safe Sleep – FCCH – 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 and removing any 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) – FCCH - This facility does not provide Incidental Medical Services – IMS currently. 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: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org – FCCH - Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law - FCCH - On this date, 7/13/2026, the California Attorney General - Megan’s Law website was verified for information on sex offenders which required to register with local law enforcement under California's Megan's Law. There are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 367700285
VISIT DATE: 07/13/2026
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Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies during today’s visit in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

Notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Licensee Peggy Smith, along with a copy of the Appeal Rights.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC809 (FAS) - (06/04)
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