197493807-1-16-2025-58-CC-KSCT-DCYV2M-20250116150323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493807
Report Date: 01/16/2025
Date Signed: 01/16/2025 03:03:36 PM

Document Has Been Signed on 01/16/2025 03:03 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SMITH FAMILY CHILD CARE		FACILITY NUMBER:	197493807
ADMINISTRATOR/ DIRECTOR:	SMITH, CYNTHIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 219-4107
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90008
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	01/16/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:13 AM
MET WITH:	Cyntia Martin Smith - Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:17 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Keyona Scott conducted an unannounced 3- Year Required Annual Inspection to the Family Child Care Home on 01/16/2025 at 9:13 AM. LPA met with Licensee, Cynthia Smith at 9:48 AM. LPA observed twelve (12) children which includes one (1) infant in care with three (3) Assistants (A1, A2, A3). All Adults present, residing and working in the home have a criminal record clearance or exemption and are associated to the facility. LPA was guided on a tour inside and outside of the home. PHYSICAL PLANT The home is a one story, five bedroom, three bathroom home with a living room, dining room, kitchen, nook, laundry room and detached garage. Per Licensee, no child care is conducted in the detached garage. The off-limit areas of the home are: the living room, located directly in front of the entrance of the home; the master bedroom and bathroom located at the entrance of the hallway; the rear bedroom and bathroom located through the hallway and at the rear of the movement room; and the detached garage located at the rear of the outdoor play area. The living room is made inaccessible by rolling cart during operation hours. The off-limit bedrooms and bathrooms are made inaccessible by closed and locked doors with safety door knobs during operation hours. The primary child care areas of the home are the classroom, located through the hallway to the left, the infant room, located through the hallway to the right, the movement room, located at the rear of the hallway and the nook located through the kitchen. LPA observed covered wall heater, covered outlets, couch, table and chair sets in the classroom. LPA also observed kitchen play sets, toy cars, books and other age-appropriate playthings in the classroom. In the infant room, LPA observed changing tables, cribs, covered outlets, labeled cubbies, covered wall heater along with the following age appropriate playthings: books, blocks, number puzzles. The infant room is utilized for napping for infants and toddlers. The movement room, is used for circle time, yoga, mindfulness activities, hooked on phonics and isolation area for child(ren) who become ill while in care. LPA observed the following in the movement room: relaxation station, tables and chairs, ottoman, stored napping cots, television, and covered wall heater. The movement room is also used as a napping area for the preschool aged children. PAGE 1

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 197493807
	VISIT DATE: 01/16/2025

NARRATIVE

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The children use the bathroom that is directly across from the classroom. LPA observed cubbies, books, dining room table in the dining room located at the entrance of the home. The nook is used during meal and snack time. LPA observed highchairs and tables and chairs in the nook. Licensee provides children in care two meals, breakfast and lunch and two snacks, morning and afternoon per day. LPA advised Licensee if food is brought from child's home to ensure food containers/water bottles are labeled with child's name and properly stored or refrigerated. Children are dropped off and picked up at the front door entrance of the home.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children in care. Home utilizes wall heaters as a heating source and window air conditioning units and ceiling fans as cooling sources. Home has a working telephone. LPA observed sharp objects and hazardous materials in the kitchen and bathroom are inaccessible to children in care. According to the Licensee, there are no weapons or firearms in the home; None were observed by LPA. Per Licensee, there are no pets in the home; None were observed by LPA.

The home is equipped with at least one fully charged fire extinguisher which is at least a 2A:10BC. The home is also equipped with at least one working smoke detector and one carbon monoxide detector. There is also a first aid kit equipped in the home.

Toys and playthings are safe, orderly and age-appropriate for the children. Licensee agrees that no baby-walkers, bouncers, jumpers, exersaucers and similar items will be used for children in care and are kept inaccessible; None were observed by LPA.

Outside play is conducted at the side and rear of the home. The outdoor play area is fully fenced in and also is free from defects or dangerous conditions. LPA observed artificial grass, cushioned mats and hand-washing station in the outdoor play area. LPA also observed the following age-appropriate play equipment in the outdoor play area: slides, activity boards, cozy coup, tricycles, basketball hoop and other age-appropriate playthings. No pools, spas, hot tubs, fish ponds, or similar bodies of waters observed during the inspection.

The facility operation hours are Monday through Friday, 7:30 AM to 5:30 PM.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 197493807
	VISIT DATE: 01/16/2025

NARRATIVE

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FACILITY RECORDS
LPA observed current Pediatric First Aid and CPR certificate for Licensee and Assistants (A1, A3) with completion dates of 07/16/2023 and Assistant (A2) with completion date of 08/13/2023. Licensee and Assistants also completed Mandated Reporter training. LPA reminded Licensee that Licensee and staff are to renew Mandated Reporter training every two years online at: www.mandatedreporter.ca.

LPA reviewed the following Personnel records for Licensee and Assistants present during inspection: LIC 508 (Criminal Record Statement), LIC 9052 (Employee Rights), LIC 9108 (Statement Acknowledging Requirement to Report Child Abuse).

LPA observed and reviewed the following Children's Records during today's inspection: LIC 282 (Affidavit Regarding Liability Insurance), Immunization Records, LIC 700 (Identification and Emergency Information), LIC 627 (Consent for Emergency Medical Treatment), LIC 995A (Notification of Parents' Rights)

LPA observed the following required posting on Parent Board at the entrance of the home:

Facility License
LIC 9148- Earthquake Preparedness Checklist

LPA provided Licensee with the following required postings to post to the Parent Board:

PUB 394- Notification of Parents' Rights

LPA reviewed the following documents during today's inspection:

LIC 610A- Emergency Disaster Plan
Verification of Disaster and Fire Drills

LPA observed log of Fire Disaster Drills conducted monthly on 08/15/2024, 09/10/2024, 10/17/2024,11/22/2024 and 12/16/2024.

LIC 9040- Facility Roster

LPA observed current Child Care Facility Roster of the children enrolled. LPA observed fourteen (14) children currently enrolled.

The facility was operating in substantial compliance during today’s inspection on 01/16/2025. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SMITH FAMILY CHILD CARE	FACILITY NUMBER: 197493807
	VISIT DATE: 01/16/2025

NARRATIVE

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The following was thoroughly discussed with Licensee:
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.

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/.

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, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

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

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.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC809 (FAS) - (06/04)

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