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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197495086
Report Date: 11/17/2023
Date Signed: 11/17/2023 01:27:55 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
09/05/2023 and conducted by Evaluator Adrian Risher
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20230905113557
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
197495086
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Tiffani Smith, LicenseeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Criminal Record Clearance:Uncleared adults providing care to day care children
INVESTIGATION FINDINGS:
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On 11/17/2023, Licensing Program Analyst (LPA) Adrian Risher conducted a complaint subsequent visit regarding the above-mentioned allegation to deliver the findings. Upon arrival, LPA met with Tiffani Smith, Licensee. LPA explained the purpose of the inspection. LPA observed 3 children in care.

On 09/05/2023, ESCCRO received a complaint regarding uncleared adults providing care to day care children. Information was reported that there are uncleared people providing care to the children.

On 09/15/2023, LPA Risher conducted the initial complaint visit. LPA Risher received a copy of the roster.

Based upon observations, record reviews and interview statements, the allegation of Criminal Record Clearance is Substantiated. Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Substantiated
Estimated Days of Completion: 85
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 30-CC-20230905113557
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 FAMILY CHILD CARE
FACILITY NUMBER: 197495086
VISIT DATE: 11/17/2023
NARRATIVE
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The names of Staff 1 and 2 were provided to LPA by the Licensee. LPA checked Guardian/LIS to confirm whether or not these 2 staff members had a fingerprint clearance on file. LPA determined that staff were not provided the proper Livescan form (LIC9163) when they submitted their fingerprints for a criminal record clearance. Therefore, staff 1 and 2 do not have criminal record clearance on file. Licensee failed to ensure that a criminal record clearance was on file prior to allowing staff to work at the daycare. This is a type A violation of Criminal Record Clearance. The licensee will be assessed a civil penalty in the amount of $1000.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit (LIC 9213) and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224) form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).

Exit interview was conducted and a copy of the report was provided. Appeal rights were reviewed and provided.

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

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 30-CC-20230905113557
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 FAMILY CHILD CARE
FACILITY NUMBER: 197495086
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/17/2023
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption
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LPA provided Licensee with LIC9163 Livescan Request. Licensee will have staff re-submit their fingerprints with the proper form and submit the receipt to LPA by 11/20/2023. Licensee will provide a written declaration stating the staff will not be allowed to work until a criminal clearance is on file.
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as required by the Department... This requiremenrt was not met as evidenced by: Licensee failed to ensure that staff had a criminal record clearance prior to working at the daycare. This poses an immediate health and safety risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/05/2023 and conducted by Evaluator Adrian Risher
COMPLAINT CONTROL NUMBER: 30-CC-20230905113557

FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
197495086
ADMINISTRATOR:TIFFANI SMITHFACILITY TYPE:
810
ADDRESS:6420 HAAS AVENUETELEPHONE:
(323) 371-0830
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:8CENSUS: 3DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Tiffani Smith, LicenseeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Licensee:Licensee is not meeting requirements of 80% at the facility
INVESTIGATION FINDINGS:
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On 11/17/2023, Licensing Program Analyst (LPA) Adrian Risher, conducted a complaint subsequent visit regarding the above-mentioned allegation to deliver the findings. Upon arrival, LPA met with Tiffani Smith, Licensee. LPA explained the purpose of the inspection. LPA observed 3 children in care.

On 09/05/2023, ESCCRO received a complaint regarding Licensee is not meeting requirements of 80% at the facility. Information was reported that the Licensee works full time as a teacher.

On 09/15/2023, LPA Risher conducted the initial complaint visit. LPA Risher received a copy of the roster.

Based on interviews and observations, there is insufficient evidence regarding the allegations of License. Licensee reported that she leaves to take her children to school and pick them up. However, there is not
Unsubstantiated
Estimated Days of Completion: 85
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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-20230905113557
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 FAMILY CHILD CARE
FACILITY NUMBER: 197495086
VISIT DATE: 11/17/2023
NARRATIVE
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enough evidence to show that the Licensee is not present at least 80% of the time. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the above alleged violations did or did not occur, therefore the allegations are found to be unsubstantiated.

Exit interview was conducted and a copy of the report was provided. Appeal rights were reviewed and provided.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5