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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700306
Report Date: 02/07/2023
Date Signed: 02/07/2023 11:05:30 AM

Document Has Been Signed on 02/07/2023 11:05 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
PALMDALE CHILD CARE, 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: 0DATE:
02/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Carla Smith, LicenseeTIME COMPLETED:
11:04 AM
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On 02/07/23 Licensing Program Analysts (LPA) Andrew Alemoh conducted a Capacity Increase inspection. Upon arrival, LPA met with licensee Carla Smith . The requested capacity is 14. The fire department has granted a fire clearance. Licensee is advised that as a family childcare home operating at full capacity, she must adhere to the following: Operate with a Maximum of 14 children in care with no more than 3 Infants, also must have 2 school age children enrolled. Or Max. 12 Capacity with no more than 4 infants. A Qualified Assistant must be present when more than 8 children are in care.

Upon arrival, LPA observed 0 children in care. This is a two story 5-bedroom, 3-bathroom home with kitchen, dining room, living room, family room, children's playroom x2, laundry room (upstairs), and garage. There is a baby gate blocking the stairs, making it inaccessible to children. There are no bodies of water on the premises. Family members residing in the home include 2 adults and 3 children (Licensee, licensee assistant daughter, foster son, daughter, son). Hours of operation are Monday-Friday, 24 hours a day. Weekends optional per parent request. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: The home is clean and orderly. Main care is provided in the day care area's (first room from the entrance of the home) and (second room in front of the kitchen) Children use the bathroom in the hallway on the right.

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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197700306
VISIT DATE: 02/07/2023
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The following were observed/discussed and or provided: Seat Belt Safety, Safe Sleep poster observed, forms required for children file (LIC311D), Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Staffing and Ratio (capacity limitations handout provided), Emergency and Disaster Information (LIC610A, LIC9148), Lead Flyer Requirement, liability insurance (LIC282) must have signed form on file if no liability insurance. Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.

The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. The facility sketch is complete and current, there is working telephone. Last fire/disaster drill was on (12/27/22). Per licensee she currently has 3 children enrolled since last year. Roster complete and maintained current. Fireplace made inaccessible with a changing table. Facility has swamp cooler and central AC and heat.

Safe and age-appropriate toys play equipment and materials were observed. Electrical outlets are inaccessible. LPA reminded licensee, no baby bouncer saucer chairs, or any recalled and or prohibited toys or sleep/play equipment are allowed on the premises. There is age-appropriate napping mats and cots provided. There are no window cords (tied high) accessible to children.

Bathroom: Bathtub and shower are free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet are clean and operable.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197700306
VISIT DATE: 02/07/2023
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Children nap on mats in the main day care area. Off limit areas include all bedrooms, laundry room, and garage, and x2 upstairs bathrooms. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with safety latch and off limit laundry room) that can pose a danger to children. Per licensee, she does not have any medicines in the home. LPA did not observe any knives or sharp items that can pose a danger to children in care.

Outdoor: Children play in the back yard. The play area is clear and clean of debris, play area is fenced and gated all around, play yard has grass and cement for play time. LPA observed a bbq pit in the backyard. LPA observed the outdoor air conditioner in the backyard inaccessible. Licensee will barricade the BBQ Pit (either a cover or barricaded with a safety gate) before children are allowed in the backyard. LPA observed age-appropriate toys for children.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Licensee has CPR/First Aid 08/23/2022, CPR/First Aid will expire on 08/23/2024. Licensee's Mandated Reporter Training was completed on 08/03/22 and expire by (8/03/24). Review of records to be maintained

Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), Large and Small Child Care Ratio Packet, and Lead Poisoning flyers. Licensee stated currently does not have childcare insurance.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 197700306
VISIT DATE: 02/07/2023
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Kitchen: The home has a clean and fully stocked clean refrigerator/freezer. Breakfast, lunch, snacks, and dinner will be provided. Food brought from the children’s home shall be labeled and dated. Per licensee kids with special diets will have the parents provide them with food.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. Licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

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.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days. Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Ready for licensure for large childcare license

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC809 (FAS) - (06/04)
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