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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806470
Report Date: 07/18/2019
Date Signed: 07/18/2019 02:04:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WILLIAMS, LINDA JOYCE FAMILY DAY CAREFACILITY NUMBER:
191806470
ADMINISTRATOR:WILLIAMS, LINDA JOYCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 971-3762
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:12CENSUS: 2DATE:
07/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Linda Joyce WilliamsTIME COMPLETED:
02:17 PM
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Licensing Program Analyst (LPA), Keyona Scott, conducted an unannounced Annual Random Inspection to ensure the health and safety of the Child Care Home according to Department Regulations and Health and Safety Codes. LPA met with Licensee, Linda Joyce Williams, on 07/18/2019 at 10:07 AM. Licensee, Licensee's Adult Son (Adult #1) and four children in care (includes two children over ten years old), were present during today's inspection. Licensee is the only Adult that is fingerprint cleared and associated to the facility. LPA was guided on a tour inside and outside of the home at 10:17 AM. There are no changes to the facility layout or to the off-limit areas of the family child care home.

Licensee's Adult Son (Adult #1), present during today's inspection, does not reside at the facility address. Per Licensee, Adult #1, comes by the facility three times a week or less to visit. Licensee stated the first two weeks of the month, Adult #1, came to visit on the weekends (Saturday and Sunday), outside of operation hours. Per Licensee, Adult #1 has been present at the facility three times this week (Tuesday, Wednesday and Thursday). Licensee failed to have Adult #1 fingerprint cleared and associated to the facility prior to Adult #1 visiting at the facility, which poses an immediate risk to the health, safety and/or personal rights of the children in care.

Per Licensee, the children in care, are grandchildren and adopted children. The Licensee stated does not care for other children outside of the grandchildren, who are from the same family household, and adopted children. Licensee cares for a total of nine grandchildren and adopted children, in which care is provided for, however, does not care for more than eight children at a time. The children cared for range from the age of seven years old to sixteen years old.
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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS, LINDA JOYCE FAMILY DAY CARE
FACILITY NUMBER: 191806470
VISIT DATE: 07/18/2019
NARRATIVE
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The licensee was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

LPA discussed AB633 and informed licensee that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee was advised that each parent or child representative must sign the LIC 9224 Acknowledgement of Receipt of Licensing Report and return by the close of the business day or upon the next day the child returns to the facility or upon a newly enrolled child within the next 12 months and place the LIC 9224 in each child's file.

The facility was not operating in substantial compliance during this inspection. The facility was cited for Title 22 deficiencies during this inspection. Please see LIC 809-D of this report for further details. The Licensee was also assessed a civil penalty for an adult present at the home that is not fingerprint cleared and associated to the facility.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

An exit interview was conducted, and a copy of this report (LIC 809), LIC 809-D, Civil Penalty Assessment (LIC 421 BG) along with appeal rights were given to Licensee, Linda Joyce Williams, whose signature confirms today's inspection and report.


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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WILLIAMS, LINDA JOYCE FAMILY DAY CARE
FACILITY NUMBER: 191806470
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2019
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance
d) All individuals subject to a criminal record review... prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption...required by Department or
This requirement is not met as evidenced by:
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Licensee states will notify Adult #1 can only come visit facility after operation hours and on the weekend. Licensee will provide LPA with a written declaration to LPA by 08/01/19 stating that no one Adult who is not fingerprint cleared and associated to the facility will be present at the facility durong operation hours.
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Based on observation, record review and interview, Adult #1, is not fingerprint cleared and assosciated to the facility. Per Licensee, Adult #1 has been present at facility for three days during the period 07/15/19 to 07/18/19.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS, LINDA JOYCE FAMILY DAY CARE
FACILITY NUMBER: 191806470
VISIT DATE: 07/18/2019
NARRATIVE
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The home is a one story, three bedroom, one and a half bathroom home with an open living room/dining room, kitchen, enclosed porch, front yard and side yard area. There is no childcare conducted in the Licensee's bedroom. The primary child care area is conducted in the open living room/dining room, enclosed porch, two bedrooms through the hallway to the right, front yard and side yard area. The children utilize the bathroom located slightly to the left of the hallway entrance. The entrance of the home is through the enclosed porch of the home from the front yard gate.

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. LPA observed an excessive amount of items, to include stacks and boxes of papers and mail, boxes, food boxes, tea cans, dog food and various other items, on the floor and tables in the open living room/dining room and enclosed porch; however, did not observe chemicals, poisons or hazardous items. The items on the floor and table prevent the children in care from being able to sit on the couch or at the table comfortably. The abundance of items, in the open living room/dining room and enclosed porch areas of the home prevent the children in care from having a safe and comfortable child care environment; which poses a potential risk to the health, safety or personal rights to the children in care. Home utilizes floor heater and portable fans as a heating and cooling source. Home has a working telephone. Hazardous materials in the kitchen and bathroom are inaccessible to children. According to the Licensee, there are no weapons or firearms at the home; None were observed by LPA. There are two pet dogs in the home that are kept inaccessible to the children in care during operation hours.

The home is equipped with a fully charged fire extinguisher which is at least a 2A:10BC. The home is also equipped with a working smoke detector and carbon monoxide detector. There is also a first aid kit equipped in the home. Licensee has current First Aid and CPR certification with an expiration date of 12/02/2019.



Toys and playthings are safe, orderly and age-appropriate for the children. Licensee agrees that no baby-walkers, bouncers, jumpers, exersaucers and similar items will be used for children in care and are kept inaccessible; None were observed by LPA. Page 2
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WILLIAMS, LINDA JOYCE FAMILY DAY CARE
FACILITY NUMBER: 191806470
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2019
Section Cited
CCR
102417(b)
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102417 Operation of Family Child Care Home
b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.


This requirement is not met as evidenced by:
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Per Licensee, will remove the items from the floor and tables in the open living room/dining room area. Licensee will send LPA pictures showing the items have been removed from the floors and tables of the open living room area by 08/01/19.
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Based on observation, LPA observed an excessive amount of items to include stacks/boxes of papers, mail, boxes, dog food and various other items, on the floor and tables in the open living room/dining room and enclosed porch; which poses a potential risk to the health, safety and/or personal rights to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 7 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS, LINDA JOYCE FAMILY DAY CARE
FACILITY NUMBER: 191806470
VISIT DATE: 07/18/2019
NARRATIVE
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The outdoor play area is fenced in and also is free from defects or dangerous conditions. No pools, spas, hot tubs, fish ponds, or similar bodies of waters observed during the inspection.

There is no Child Care Facility Roster review due to children Licensee provides care for are only for the Licensee's grandchildren and adopted children.



Hours of operation are Monday through Friday from 6:00 AM to 6:00 PM.

Licensee states is not providing IMS (Incidental Medical Services) services at this time.



Update on Incidental Medical Services: 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

The following was thoroughly discussed with the licensee:


All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS, LINDA JOYCE FAMILY DAY CARE
FACILITY NUMBER: 191806470
VISIT DATE: 07/18/2019
NARRATIVE
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Licensee was reminded it is the Licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

Licensee informed Fire Disaster Drills are to be conducted at least once every month and log must be kept.



Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24 hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome

The licensee was also recommended the following Safe Sleep Practices: always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold. Please note, these guidelines are recommendations for best practices only, until regulations are approved and adopted. Page 4
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7