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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495086
Report Date: 01/04/2024
Date Signed: 01/04/2024 10:02:29 AM

Document Has Been Signed on 01/04/2024 10:02 AM - 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:TIFFANI SMITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 371-0830
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
01/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Tiffani Smith, LicenseeTIME COMPLETED:
09:20 AM
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On 01/04/2024 at 8:50am, Licensing Program Analyst (LPA) Adrian Risher conducted an unannounced case management-deficiencies inspection to determine if the deficiencies cited on 11/17/2023 have been cleared. LPA met with Tiffani Smith, Licensee and toured the facility. There was 4 children present at the time of the inspection.

On 11/17/2023, the facility was cited under section code 102370 Criminal Record Clearance. Licensee stated that she had 2 assistants working at the facility. LPA Risher determined that the assistants did not have a criminal record clearance on file. LPA Risher discovered that the assistants were not given the proper LIvescan form (LIC9163) prior to submitting their fingerprints.

Licensee provided the following items to LPA: proof of criminal record clearance for Assistant 1 and Assistant 2

Deficiencies cited on 11/17/2023 have been cleared. Plan of correction letter was provided to the licensee.

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: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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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