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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413640
Report Date: 10/04/2019
Date Signed: 10/07/2019 11:15:08 AM

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 FAMILY CHILD CAREFACILITY NUMBER:
197413640
ADMINISTRATOR:WILLIAMS, ELLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 217-9204
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY:14CENSUS: 3DATE:
10/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ellen WilliamsTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), V. Wheatley conducted a annual inspection and met with the licensee Ellen Williams at 2PM. LPA observed three children on the premises of which two were napping. LPA toured the areas of day care which is the living room and the family room.

LPA observed a working smoke detector, carbon monoxide, charged 2A10BC fire extinguisher and working telephone. The home has central heating and air condition. There are several age appropriate toys and equipment. LPA observed the electrical outlets inaccessible to children. Per the licensee, there is one inoperable firearm in a lockbox on the premises. The ammunition is located in a separate lockbox. Licensee has current CPR and first aid which expires October 2020.

LPA inspected the front yard which is fenced. The yard is large with age appropriate toys and equipment. There are no pets and no bodies of water. Licensee was reminded to empty any water tables after each use.

Licensee was informed regarding Incidental Medical Services. According to licensee, there are no children with Incidental Medical Services. Licensee understands that if children are receiving these services, a written plan must be submitted to the department.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197413640
VISIT DATE: 10/04/2019
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LPA reminded licensee that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). Licensee reminded about Safe Sleep regarding infants sleeping on their backs. Also, no smoking is allowed on a day care premises. Never shake a baby to prevent Shaken Baby Syndrome. Children may only be in high chairs if they are eating. Hands must be washed after every diaper change. No baby walkers, exersaucers or baby bouncers are allowed on day care premises.

LPA discussed discipline policies, personal rights, civil penalties and appeal rights. LPA reminded licensee that unusual incidents and injuries are to be reported within 24 hours.

LPA reviewed children's records at 2:45PM. Immunization records are obtained from parent's prior to a child being left with provider. Immunization records shall be kept on blue cards from the local health department. The licensee has Mandated Reporter Training. Title 22 Regulations, child care quarterly updates and additional information may be obtained at the department's website www.ccld.ca.gov

LPA observed the required documents posted on the parent board. The children's roster is posted.

LPA did not observe any Title 22 Regulations violations.

Exit interview.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
LIC809 (FAS) - (06/04)
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