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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494601
Report Date: 11/08/2022
Date Signed: 11/14/2022 03:49:22 PM

Document Has Been Signed on 11/14/2022 03:49 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
197494601
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Zekaiai L. Smitth TIME COMPLETED:
04:30 PM
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On 11/08/2022 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Zekaia Smith. Present during today’s inspection was Licensee and assistant Jerald McNeil. No children were present during today’s inspection.

Days and hours of operation are 5:00 am to 11:30 p.m., Monday through Saturday. Currently applicant cares for children ages 3 months to 13 years old. Facility does not have any children under the age of 12 months enrolled in the program, but is available for infant care.

LPA toured the home inside and outside and a census was taken; no children were present during today’s inspection. The home is located in a 4 unit building, Unit A located in the bottom floor with living room, kitchen and dining room area, hallway with bedroom 1 and bedroom 2 and bathroom. Facility does not have any outdoor space.

Licensee confirmed the following areas are used for day care: living room, kitchen and dining room area, bedroom 2 and bathroom.

Bedroom 1 is designated as OFF LIMITS to the children in care. LPA observed a safety plastic knob cover making the door inaccessible.

LPA observed an open face heater in the hallway, heater was observed to be barricade with a metal gate making it inaccessible to the children in care.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents and cleaning compounds are kept locked in the bottom kitchen cabinet, making the content inaccessible to the children in care. Sharp object and knives were observed in a locked drawers in the kitchen- content inaccessible to the children in care.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 FAMILY CHILD CARE
FACILITY NUMBER: 197494601
VISIT DATE: 11/08/2022
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The home was observed having a working fire extinguisher mounted inside the closet next to the living room. Carbon monoxide and smoke detector were observed in the hallway next to bedroom 1 and inside bedroom 2. LPA observed licensee test the carbon monoxide and smoke detector in the home.

Licensee confirmed program is available for infant care. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping

Adequate heating and ventilation for safety and comfort were observed in the space. LPA did no to observe any stairs in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number as (424) 214-8203.

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.

LPA reviewed a sample of children’s files and observed files were completed. LPA provided licensee a copy of the LIC 311D with a sample of all necessary LIC forms and Lead Prevention Flyer to ensure that all files are complete and updated.

Mandated Reporter Training was taken on 3/7/2022. Licensee’s pediatric CPR/First Aid was reviewed and observed to have an expiration date of 10/2023.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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/process.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197494601
VISIT DATE: 11/08/2022
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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.

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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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