<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216476
Report Date: 11/10/2022
Date Signed: 11/10/2022 01:29:36 PM

Document Has Been Signed on 11/10/2022 01:29 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
426216476
ADMINISTRATOR:MELISSA SMITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 268-8500
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/10/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Melissa SmithTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
This is a a Change of Location, previous facility no. 426216206.
On 11/10/2022 at 12:50 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre Licensing inspection and met with applicant, Melissa Smith and discussed the nature of the inspection. LPA asked applicant pre- screening questions related to COVID-19, Applicant's responses suggest no COVID-19 exposure on site. There were no children present at the time of the inspection.

LPA in the company of the applicant toured the interior and exterior of the home. During this tour the following was noted:

Applicant applied for change of location on 10/26/2022. Per Applicant, the operating hours will be Monday through Friday from 7:30 AM to 4:30 PM. All areas identified on the facility sketch were Database Link Iconinspected. Home is a one story composed of 3 bedrooms and 2 bathrooms. The master's bedroom is converted to a day care area, the backyard, hall way, one bathroom will be accessible to children. Living room, kitchen, dining area and garage will not be accessible to children. The backyard is enclosed with a wooden fence. LPA observed age appropriate toys and equipment inside and outside the home. Hazardous items are stored inaccessible to day care children. LPA observed smoke detector and carbon monoxide detector, Fire Extinguisher was serviced on 5/12/2022. Per Applicant, there are no guns nor ammunition in the home. LPA did not observe any bodies of water.

First Aid and emergency kits are available. The Applicant's First Aid and CPR expires 5/15/2024. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles. Mandated Reporter Training expires on 1/15/2024. Continued on LIC -809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 426216476
VISIT DATE: 11/10/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA discussed Safe Sleep Regulations with Applicant.

Applicant is not providing Incidental Medical Services (IMS). 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.



Fire Safety Inspection Clearance was granted on 11/9/2022. Home is approved for a Large Family Child Care License effective today, 11/10/2022. Applicant was made aware that she can provide care for a maximum of 12 children. LPA discussed that landlord consent is required for capacity of more than 12 or up to 14 children. LPA provided the Regulations on 102416.5 Staffing Ratio and Capacity under Health and Safety Code section 1597.465 . Applicant stated she will provide care only for maximum of 12 children and she does not have school age children except for applicant's own child. LPA reviewed the Control of Property.

Notice of Site Visit was issued. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY. Appeal Rights were provided.

Exit interview and Report was discussed with applicant. Melissa Smith

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2