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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416257
Report Date: 05/24/2022
Date Signed: 05/24/2022 02:01:00 PM


Document Has Been Signed on 05/24/2022 02:01 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
197416257
ADMINISTRATOR:WILLIAMS, KOLANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 482-9584
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:14CENSUS: 4DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kolani WilliamsTIME COMPLETED:
12:30 PM
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On 5/24/2022 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Kolani Williams.

Days and hours of operation are 24 hours of day Monday through Sunday. Applicant confirmed that overnight care is by appointment only. LPA discussed overnight care and requirements regarding operating a program that is open 24 hours. Facility is open to care for children ages 3 months 12 years old.

LPA toured the home inside and outside and a census was taken; 4 children were present and licensee and 3 assistants were providing care and supervision. Licensee confirmed that bedroom 1, the living room, eating area and sun room have been designated for child care. The bathroom that children use is located outside bedroom 2. Licensee confirmed the following areas area OFF LIMITS: Bedroom 2 and detached garage. Areas are made inaccessible maintaining doors locked during hours of operations. LPA observed a children’s safety gate making the kitchen inaccessible to the children in care. Kitchen is used as a walkway to access the backyard. Families enter the facility through the side of the home.

Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. No poisons were observed during the inspection.

Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.They are located under the sink with a safety latch, making them inaccessible.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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 5


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: 197416257
VISIT DATE: 05/24/2022
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There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

The home is a single-family home with 2 bedrooms, bathroom, living room, eating room kitchen and detached garage. The home has a working telephone service and LPA confirmed the phone number is (626) 482-9584. Safe toys and play equipment are observed.

LPA observed 2 infants in care. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete and LPA will email licensee LIC311D. LPA was not able to review one child's file and Licensee agreed to ensure all documents are file. Licensee and three assistants have completed the Mandated Reporter Training and LPA reviewed certificate of completion. Pediatric CPR/First Aid certification of licensee and three assistants was reviewed by LPA.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 197416257
VISIT DATE: 05/24/2022
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A review of records was not available for immunization requirements and licensee was given a technical advisory and will submit proof to LPA vial email by 6/7/2022 immunization records for MMR and Tdapt and influenza/flu for licensee and 3 assistants.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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/inspection-process.

Licensee was reminded that all adults 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.

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-and-resources/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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted and report was reviewed with the licensee Kolani Williams.
Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5