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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417120
Report Date: 04/18/2024
Date Signed: 04/18/2024 12:02:57 PM


Document Has Been Signed on 04/18/2024 12:02 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
197417120
ADMINISTRATOR:WILLIAMS, GERALDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 637-1109
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:14CENSUS: 9DATE:
04/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Gerald WilliamsTIME COMPLETED:
12:30 PM
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On April 18, 2024 at 10:00 am, Licensing Program Analysts (LPA) Angelica Wallin, conducted an unannounced Annual Required Inspection and was met by Licensee, Gerald Williams. Hours of operation are from Monday to Friday from 6:00 am – 6:00pm. LPA toured the home inside and outside and a census was taken.

This one - story home consists of 4 bedrooms and 2 bathrooms. Areas used by children include living room as the day care room, one bedroom as the infant room, one bedroom as the nap room, two restrooms, one bedroom as the game room, and backyard. Per Licensee, areas off limits include: one bedroom, kitchen, front yard and shed in backyard. LAP observed off-limit areas are made inaccessible via lock and key and a security gate. There are 9 children and one staff present during time of inspection. Licensee stated that there are currently 14 children enrolled in the facility.

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 noted space with age-appropriate toys. There is a working smoke and carbon monoxide detector. During inspection, LPA observed fire extinguisher with service tag dated 6/2023. During inspection, LPA observed cleaning supplies located in off-limits kitchen cabinet under the sink with child-proof latch. LPA observed knives located in kitchen drawer with child proof latch inaccessible to children in care. According to the applicant, there are no weapons or firearms at the home; LPA did not observe any firearms or weapons at the time of the inspection.

Per licensee, outdoor play conducted in the back yard. LPA observed back yard is fenced and contains no hazardous items that can pose a danger to children. LPA observed off-limits shed located in the backyard is locked with pad lock and inaccessible to children in care. LPA advised licensee that total supervision to be maintained at all times during outdoor play. LPA observed there no swimming pool or bodies of water.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 854-7636
LICENSING EVALUATOR NAME: Angelica WallinTELEPHONE: (626) 366-3613
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197417120
VISIT DATE: 04/18/2024
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Per licensee, food service and transportation is provided. Per licensee, overnight care is not provided at this time. LPA discussed with licensee supervision and safety when providing transportation services.

During inspection, five children’s records were reviewed. During child record review, LPA observed LIC9221 for one children's file missing parent signature. A technical violation citation issued. During child record review, LPA observed 15-minute infant sleep log conducted, but LIC9227 form not completed for 9 month infant in care. Per licensee, he was not aware of form to be completed. LPA reviewed LIC9227 with licensee during inspection. A technical violation citation issued.



A review of staff records indicates that licensee and one staff has the following updated certificates: mandated reporter certificate for licensee with expiration date of 9/2025, mandated reporter certificate for one staff with expiration date of 8/2024, updated CPR/1st aid certificate for licensee with expiration date of 9/2025, updated CPR/1st aid certificate for one staff with expiration date of 10/2024. During staff record review, LPA observed the following immunizations missing for licensee and one staff: pertussis for both licensee and one staff and TB clearance for one staff. LPA reviewed the following documentation to be kept in facility: facility license, LIC610A, facility fire drill logs, PUB 394, and LIC9040.

Licensee Williams was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation. LPA reviewed with Licensee Williams items prohibited in FCCH, no baby bouncers, no infant walkers, No Johnny jumpers, no saucer chairs, and any other item that falls into that category are not permitted in the facility.

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 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.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 854-7636
LICENSING EVALUATOR NAME: Angelica WallinTELEPHONE: (626) 366-3613
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197417120
VISIT DATE: 04/18/2024
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This facility does not provides Incidental Medical Services – IMS. 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/

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

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.

Exit interview conducted and report was reviewed with licensee, Gerald Williams. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 854-7636
LICENSING EVALUATOR NAME: Angelica WallinTELEPHONE: (626) 366-3613
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 04/18/2024 12:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197417120

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the following immunizations missing for licensee and one staff: pertussis for both licensee and one staff and TB clearance for one staff, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/02/2024
Plan of Correction
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Per licensee, immunization records for pertussis and TB clearance to be obtained and picture proof to be submitted via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Karen ChambersTELEPHONE: (323) 854-7636
LICENSING EVALUATOR NAME: Angelica WallinTELEPHONE: (626) 366-3613
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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