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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007090
Report Date: 02/01/2023
Date Signed: 02/01/2023 02:20:57 PM

Document Has Been Signed on 02/01/2023 02:20 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
198007090
ADMINISTRATOR:SMITH, SHERRYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 759-8028
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Licensee Sherry SmitchTIME COMPLETED:
02:35 PM
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On 2/1/23 at 12:25 PM Licensing Program Analysts (LPAs) Austin Estrada and Jeanette Estrada conducted an unannounced required 1-year inspection at the above facility. LPAs met with the Licensee Sherry Smith and informed her of the purpose for the visit. LPA provided the inspection Entrance Checklist (LIC 126). Licensee guided LPA on a tour of the facility. There were no children present during the inspection. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages newborn to 13 years old and operation days/ hours are Monday through Saturday 23 hours per day. Licensee was advised that care cannot be provided continuously for over 24 hours.

This is a one story 4 bedroom, 2 bathroom home with an additional dwelling unit (ADU) located at the back of the property. Off limits areas include the entire front home and the front yard. All child care is provided in the additional dwelling unit which includes a playroom, nap room, kitchen and bathroom. Also on limits to children is the backyard (fenced). Per Licensee, children and parents use the side gate as an entrance to the additional dwelling unit.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted in play room.

Facility records were reviewed for LIC 9040- Facility Roster, LIC 610A- Emergency Disaster Plan and Verification of Disaster and Fire Drills. The last drill was conducted on 1/10/23. All documents were observed during the inspection.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198007090
VISIT DATE: 02/01/2023
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There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) was observed and last serviced on 6/14/22. The home maintains telephone service (landline/mobile). LPA observed cleaning compounds, sharp objects such as knives located in off limits kitchen area inaccessible to children in care. Per Licensee, no children require medication.

Per Licensee there are no poisons stored in the home. LPA advised Licensee that all poisons must be locked away, not only inaccessible. Isolation area for sick children waiting to be picked up is in the nap room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Food is provided by Licensee. LPA advised Licensee if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

The additional dwelling unit was observed to be clean and orderly. There are toys and other age-appropriate materials available for children.

The outdoor play area was observed to be fenced and contain toys and other age- appropriate materials available for children. Per Licensee, children are supervised while playing outside. LPA did not observe any pools, spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months) All records were observed to be complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. All records were observed to be complete. LPAs advised Licensee that CPR/first aid certificates should be conducted through a certified EMSA provider.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198007090
VISIT DATE: 02/01/2023
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Infant Care: Licensee currently does not care for any infants. LPAs observed three cribs in the nap room. LPA reviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA 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 provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect. Overnight Care: Per Licensee, there is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing IMS must be submitted to the Department.
The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm
LPA also informed licensee 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 advised Licensee that all adults age 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.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process. Per LPAs observations and records review, no deficiencies are being cited today, 2/1/23. An exit interview was conducted and report was reviewed with Licensee, Sherry Smith. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal rights were discussed and provided to the Licensee.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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