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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700306
Report Date: 08/31/2022
Date Signed: 08/31/2022 04:05:35 PM

Document Has Been Signed on 08/31/2022 04:05 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
197700306
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
08/31/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Carla SmithTIME COMPLETED:
04:25 PM
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On 8/31/2022 Licensing Program Analyst (LPA) Isabel Ortega met with above facility's licensee, Carla Smith. LPA was at the facility to conduct a case management and a health and wellness inspection. LPA disclosed the purpose of the inspection and was granted entry into the licensee

Upon arrival LPA verified a census of two child in care. Per the licensee older school age child is in JR. High and has a different schedule Monday through Friday from 5:00 p.m. - 11:00p.m. Therefore, Child #2 is not present and will be picked up at 5:00 p.m.
During today's inspection LPA inspected the areas where child care is provided.

Licensee was reminded to continue increasing care and supervision during indoor and outdoor activities.

The facility was in compliance per Title 22 regulations, and no deficiencies were cite during today's inspection.

An exit interview was conducted, a copy of this report, and notice of site visit were provided to licensee, Carla Smith
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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