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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495086
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:52:04 PM

Document Has Been Signed on 06/23/2022 03:52 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:
197495086
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/23/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tiffani Smith LicenseeTIME COMPLETED:
04:15 PM
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On 06/23/2022, Licensing Program Analyst (LPA) Adrian Risher conducted a pre-licensing inspection for a family child care home. LPA met with applicant Tiffani Smith and toured the facility. The applicant and her son are the only individuals present at the time of the inspection. LPA did not observe any children present. The home is clean, orderly and comfortable. All adults in the home have been fingerprinted and associated to the facility. The hours of operation will be 6:00am to 6:00pm Monday thru Friday. Applicant is requesting to have a family child care home with a capacity of 8.

The single family home is 3 bedrooms and 1 bathroom. The daycare will consist of the living room, dining room, bathroom and kitchen. These areas were inspected by LPA. The other bedrooms and rooms are considered off-limits and inaccessible. The living room will be used for daily activities and napping. The dining room will be used for eating. Applicant is renting the home. Applicant provided property owner/landlord consent form with the application. The parents will enter home from the front entrance. LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children. Licensee will put safety locks on the lower cabinets in the kitchen. The hallway near the bathroom will be used as the isolation area for ill children.

LPA observed age appropriate toys, furniture and activities for children while in care at the facility. LPA observed rocks(gravel) in the outside play area. Applicant was advised that she can place rubber mats over the rocks in the outside play area. LPA observed the outside play area gated all around.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197495086
VISIT DATE: 06/23/2022
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Applicant will purchase a fire extinguisher at least the size of 2 A 10 BC . Applicant will provide a video of herself testing the carbon monoxide detector & smoke detector. Applicant has a first aid kit which band aids and a thermometer. The home has central air & heat heating.

Applicant has current CPR, first aid, health and safety which expires 06/2024. Per the applicant, there are no firearms on the premises. Applicant reports that there are no pets in the home. LPA did not observe any baby walkers, exersaucers or bouncers.



The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible.
Applicant has provided copies of immunization records. Applicant a copy of mandated reporter certificate.


The following corrections were discussed with applicant in order for the home to be ready for conducting child care:

1. Fire Extinguisher
2. Test Smoke Detector & Carbon Monoxide Detector
3. Remove glass tables, mirror and exercise equipment from living room & dining room
4. place safety hooks or latches on lower cabinets in kitchen & bathroom
5. Preventative Health & Safety Certificate
6. Mandated reporter Certificate

A license to operate a Small Family child care home will be reviewed following final administrative review, and receipt of outstanding corrections needed. No license will be issued today 06/23/2022. Applicant will notify LPA when corrections have been made, and the Applicant has 30days to complete corrections.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
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: 197495086
VISIT DATE: 06/23/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 applicant 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 applicant 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

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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 platform.

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.

Exit interview conducted and report was reviewed with the applicant Tiffani Smith

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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