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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197415662
Report Date: 10/24/2022
Date Signed: 10/24/2022 02:40:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2022 and conducted by Evaluator Miriam Cohen
COMPLAINT CONTROL NUMBER: 30-CC-20220815092244

FACILITY NAME:SMITH & MERRITT FAMILY CHILD CARE HOMEFACILITY NUMBER:
197415662
ADMINISTRATOR:SMITH, JACQUELYN M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 704-9305
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY:14CENSUS: 8DATE:
10/24/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Temeka Merrit, Designated PersonnelTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility has bed bugs
INVESTIGATION FINDINGS:
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On 10/24/2022 at 2:06 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced visit and met with licensee, Jaquelyn Smith, for the purpose of delivering the finding concerning the mentioned allegation. Based upon the following observations below, facts revealed that, there is a preponderance of the evidence to support that the facility committed the allegation: Facility has bed bugs
A. Verbal interview with licensee with written declaration
B. Pest Control Service Agreement
Therefore, the following conclusion has been determined concerning the above allegation: Substantiated - A finding that a complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
The facility was cited a Type B deficiency according to California Code of Regulations Title 22 (See LIC 9099D report for deficiencies). Licensee is to post notice of Site Visit for 30 Days, failure to do so will result in $100 immediate civil penalty.
An exit interview and a copy of this report along with Appeal Rights were explained and provided licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 30-CC-20220815092244
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH & MERRITT FAMILY CHILD CARE HOME
FACILITY NUMBER: 197415662
VISIT DATE: 10/24/2022
NARRATIVE
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On 08/23/2022 @ 10:30 AM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced 10-day complaint visit and notified the licensee, Bertha Merritt, concerning the above allegations. During the visit, LPA toured the facility electronically (via facetime) and observed licensee and one staff providing care for seven children, (six preschoolers and one infant). LPA obtained copies of the following: Current children roster with Emergency ID, written declarations from the licensee, copy of weekly menus, receipts of food recently purchased from the grocery store, UIR (Lic 624b) for bed bugs, Pest Control service agreement, UIR for COVID positive test results, and daily and weekly cleaning checklist logs. Further witnesses and documentation will be needed to conclude the investigation.

An exit interview was conducted with the above items discussed with Ms. Merritt. A copy of this report was provided to licensee.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC9099 (FAS) - (06/04)
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