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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198015114
Report Date: 12/30/2020
Date Signed: 12/30/2020 12:48:45 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2020 and conducted by Evaluator Betty Bell
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20201214164320
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
198015114
ADMINISTRATOR:WILLIAMS, SHEREAL ELISIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 731-7381
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:14CENSUS: 0DATE:
12/30/2020
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee Shereal Lisa WilliamsTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Provider pushed day care child while in care
INVESTIGATION FINDINGS:
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An unannounced tele-inspection was conducted by Licensing Program Analyst (LPA) Emiko Bell on 12/30/20, via Zoom, due to COVID-19 and precautionary measures. The purpose of the tele-inspection was to provide the findings of the Complaint investigation. The tele-inspection was conducted with Licensee Shereal Williams, to whom the purpose of the inspection was announced.

Census: Zero. Per licensee, she is open, but there are no children in attendance.

Throughout the course of the investigation, interviews were conducted with licensee, one adult, one minor, and the Reporting Party and documentation in the form of call logs on two cell phones were viewed and the text of two text messages were documented.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 33-CC-20201214164320
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198015114
VISIT DATE: 12/30/2020
NARRATIVE
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-Pertaining to the allegation that “Provider pushed day care child while in care”: this allegation refers to an incident which occurred on Saturday, December 12. The facts are: according to call logs viewed, the reporting party (RP) made a phone call to licensee at 06:11 am. and licensee phoned the RP back at 06:13 am. At some point after 06:13 am, Child #1 was let into the residence by Adult #1 as the situation between licensee and RP escalated to the point that licensee put hands on Child #1. According to RP, licensee pushed Child #1 out of the residence, causing Child #1 to hit their head on the door, causing a bump, and causing them to drop their belongings. According to licensee, she had her hand on the back of Child #1 and was “moving” Child #1 out of the door, but wouldn't say that she pushed Child #1. Per licensee and Adult #1, Child #1 did not fall on the ground. Child #1 was unable to be interviewed. Child #2 overheard the situation but was not a visual witness to the incidents.

Therefore, as it is unknown whether Child #1 was “moved” by the licensee or pushed hard enough that Child #1 bumped their head and fell on the ground, dropping their belongings, the allegation has been determined to be Unsubstantiated, as no corroborating statements were made.

Licensee Williams reported the incident to Community Care Licensing on 12/14/20.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 33-CC-20201214164320
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198015114
VISIT DATE: 12/30/2020
NARRATIVE
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This agency has investigated the complaint alleging that there was a violation of Title 22, Division 12, Chapter 1, Article 6, Section 102423 "Personal Rights." The complaint alleged that “provider pushed day care child while in care.” Based upon the evidence as presented above, the allegation has been determined to be Unsubstantiated. A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Therefore, no citations will be issued for the allegation listed above.

An exit interview has been conducted with Licensee Shereal Williams. Appeal Rights were verbally explained to Licensee as well. A copy of this report has been signed by LPA Bell. This report and the Appeal Rights will be scanned via e-mail to Licensee Williams, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A Notice of Site Visit was not provided to Licensee Williams since a physical inspection was not conducted.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3