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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019823
Report Date: 04/04/2025
Date Signed: 04/04/2025 12:41:59 PM

Document Has Been Signed on 04/04/2025 12:41 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
198019823
ADMINISTRATOR/
DIRECTOR:		SHERIAH R. SMITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 988-8262
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
04/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:Sheriah Smith, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Licensing Program Analysts (LPA) Tyler Reyes and Ashley Calderon conducted an unannounced Annual/Random inspection at the above facility. LPAs met with Sheriah Smith, Licensee and provided an Entrance Checklist-Family Child Care Homes LIC 126. LPAs conducted a tour of the facility led by Licensee Sheriah. LPAs observed (6) six children in care during inspection. Per Licensee there are (7) seven children currently enrolled. Per Licensee Sheriah hours of operation are Monday to Friday 6AM to 6PM, however, Licensee is available 24 hours if needed but understands and does not to exceed 24 hour care at one time. The licensee’s facility serves children newborn to 12 years. The licensee is approved to care for MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

During the inspection, the following individuals were present in the home: Licensee, Staff 1, and Staff 2. Any individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

Facility Postings: LPAs observed the required posting in the daycare room Facility License, PUB 394 Notification of Parents’ Rights, LIC 9148 Earthquake Preparedness, LIC 610A Emergency Disaster Plan, and LIC 9040 Children Roster.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198019823
VISIT DATE: 04/04/2025
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Pediatric CPR/First Aid in Pediatrics Certification: Licensee Date Completed 2024- 11-05

Valid Period: 2years

Emergency Disaster Drill: Fire Drill conducted on 3/14/25

Facility Sketch: This is a one-story home which consists of three bedrooms, two bathrooms, kitchen, living room, enclosed patio, front yard and backyard (fenced). Children’s areas include the living room, one bathroom, and backyard. The children use the bathroom located in the rear hallway. The restroom that children use was observed safe and sanitary. Per the Licensee, areas off limits to children and parents include: master bathroom and all bedrooms, kitchen, and garage.

Infants: LPAs observed (2) infant in care. Napping equipment was observed, including (6) play yards, each equipped with a mattress and fitted sheet. The infant sleep log was reviewed, which included the date, infant’s name, and the time of each 15-minute check. The LIC 9227 Individual Sleep Plan was also reviewed for infant up to 12 months of age. Per Licensee all sheets and blankets are washed in the facility once a week on Friday and as needed

Meals: Per Licensee, children will have meals in living room. Licensee will provide meals for children. The Licensee was advised to ensure all food brought from home is properly labeled and stored. Children have no reported allergies.

Medication: Per Licensee the facility will provide incidental medical services. If required, medication will be stored in locked bedroom centrally stored and inaccessible to children. Medications will be administered in accordance with PIN 22-02-CCP, which outlines requirements for proper storage, documentation, and staff training. No children receiving medication.

The following on-limit areas that will be used by children were inspected for safety, comfort, and cleanliness. LPAs observed age-appropriate toys and learning materials. Telephone service is provided via cell phone. The facility is heated and cooled by a central air conditioner.

The fireplace has been blocked and gated. LPAs observed a 2A10BC fire extinguisher located in the kitchen fully charged with a service date of 2/27/25. The home has an operable smoke and carbon monoxide detector located in the living room. The first aid kit is kept in living room. Isolation area for sick children is the living room.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198019823
VISIT DATE: 04/04/2025
NARRATIVE
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Poisons are not kept in the home. Cleaning products are centrally stored underneath the kitchen sink with a childproof latch. Sharps are centrally stored in a tray in the top kitchen cabinet. There is no personal hygiene supplies accessible to children in the restroom. There are no firearms on the premises. If firearms are present, LPAs verified per Title 22 regulations that they are locked, with ammunition stored separately. LPAs observed facility has childproof electrical outlet covers. No bodies of water were observed. Per licensee have (1) dog and dog is kept in off limits bedroom.

Outdoor: Children are using the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. No animal feces were observed.

Staff Files: LPAs reviewed Licensee and (2) staff files which included the following documentation: LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirements to Report Child Abuse, Proof of Immunization, and Mandated Reporting Training Certificate. Staff had all required documentation.

Children Files: LPAs reviewed (5) children files, which included the following documentation: LIC 282 Affidavit Regarding Liability Insurance, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 9224 Acknowledgment of Receipt of Licensing Reports it was not applicable. (5) of (5) children had all required documentation.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198019823
VISIT DATE: 04/04/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working

in the home, including employees and volunteers, except as specified in Health and Safety

Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a

repeat violation, for a maximum of 30 days per person will be assessed if this regulation is

violated.

LPA discussed the safe sleep regulations with licensee and

discussed the Child Care Licensing Safe Sleep webpage at

https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/

safe-sleep as an additional resource. 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.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198019823
VISIT DATE: 04/04/2025
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-

CCP. 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 Centers and the

ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a

consumer education website that helps families obtain child care by connecting them to child

care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Sheriah Smith confirmed that there are no Registered Sex

Offenders living in the facility and LPA completed the RSO profile in FAS on 4/4/25.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Sheriah Smith, Licensee

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC809 (FAS) - (06/04)
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