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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415662
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:02:01 PM

Document Has Been Signed on 12/12/2023 03:02 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
197415662
ADMINISTRATOR:JACQUELYN SMITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 704-9305
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/12/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Licensee, Jacqueline Smith TIME COMPLETED:
03:10 PM
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On 12/12/2023 at 11:17am, Licensing Program Analyst (LPA), Sarah Garcia conducted an unannounced Required Inspection at the above-mentioned facility. LPA was greeted by assistant, Temeka Merritt. During the initial inspection, LPA observed 6 children in care with two assistants. Facility operates Monday through Friday from 7:30 a.m. to 6:00 p.m. Currently licensee is available to care for children 1 years old to 5 years old. Facility is Large Family Child Care Home with a max capacity of 14. Licensee does not provide transportation to children. At 11:30am, licensee, Jacquelyn Smith arrived at the facility and LPA continued inspection with licensee. During the inspection, LPA observed a tenant who resides in the home. All adults have been fingerprint cleared and associated to the facility.

LPA toured the home inside and outside. The home is a two story home with 5 bedrooms and 3 bathrooms, living room dining room, kitchen area, second living room (classroom), attached garage (play room), and outdoor area. The entire second floor is off-limits to the children in care. Licensee confirmed the following areas are designated for day care only: Second Living room (classroom), bedroom #1 (nursery), bathroom #1, attached garage (play room), and outdoor area. LPA inspected the living room and observed the space to be clean and orderly. LPA observed a barricaded non-operational fireplace. LPA inspected the second living room (classroom) and observed a worker painting the classroom. The classroom was blocked off with tape and off-limits while in the process of being painted. LPA inspected the attached garage (play room) and observed cots to utilize for sleeping children. LPA observed age-appropriate toys, materials, children's tables and books. LPA inspected the bedroom #1 (nursery) and observed three play yards to utilize for sleeping infants. LPA observed cleaning supplies in the top shelf of the nursery closet. The bathroom #1 that children use is located near the front door and attached garage (play room). LPA inspected the bathroom #1 and did not observe any medications, toxins or cleaning compounds accessible to the children in care. LPA inspected the kitchen and observed the knives and sharp objects to be out of reach to the children. Page 1

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197415662
VISIT DATE: 12/12/2023
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LPA observed the poisons, detergents, cleaning compounds, medications and other items which can pose a risk to children in care on the top cabinet above the refrigerator making them inaccessible

The following areas are OFF LIMITS to the children in care: Bedroom #1, bedroom #2, bedroom #3, bedroom #4, bathroom #2, bathroom #3, living room, dining room, and kitchen area. The entire second floor is off-limits to the children in care. LPA observed a safety gate at the foot of the stairs leading to the second floor.

LPA inspected the outdoor area and observed safe toys and play equipment. Outdoor area is clean and free from debris. The outdoor area is properly fenced and supervised at all times. Per licensee, there are no pets in the home.

All electrical outlets were observed to be covered. LPA reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed, locked, and made inaccessible when children are present.



LPA observed assistant test the carbon monoxide detector in the home. LPA observed assistant test the smoke detector in the home. One working fire extinguisher 2A10BC was observed. LPA observed first aid kit with thermometer and Band-Aids. Licensee provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted. When a child is ill licensee will isolate them in the bedroom #1 (nursery).

No swimming pools or bodies of water were observed in the space. There are no firearms or ammunition on the premises.

Licensee currently does not administer medication. Adequate ventilation for safety and comfort were observed in the space. Licensee has A/C unit and portable heaters. The home has working telephone service and LPA confirmed the phone number (310) 704- 9305.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained during today’s inspection.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197415662
VISIT DATE: 12/12/2023
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LPA reviewed 6 children’s files and observed files to be complete. LPA discussed all necessary forms needed in each children’s file and provided licensee with the LIC 311D- Records to be maintain in the facility and provided licensee with a current copy to use as a reference when auditing files.

LPA reviewed Licensee’s 3 certifications: Heartsaver Instructor certification with an expiration date of 09/2024, Basic Life Support Instructor certification with an expiration date of 09/2024, and Basic Life Support Provider certification with an expiration date of 09/2024. LPA reviewed licensee’s Mandated Reporter training and observed certification with an expiration date of 12/2025.

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.



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 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) 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/.


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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197415662
VISIT DATE: 12/12/2023
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Jacquelyn Smith, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies will be cited.

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

Exit interview conducted and report along with appeal rights was reviewed with the licensee, Jacquelyn Smith.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC809 (FAS) - (06/04)
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