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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015114
Report Date: 08/20/2021
Date Signed: 08/20/2021 04:42:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CAREFACILITY NUMBER:
198015114
ADMINISTRATOR:WILLIAMS, SHEREAL ELISIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 731-7381
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:14CENSUS: 6DATE:
08/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Licensee Shereal WilliamsTIME COMPLETED:
04:45 PM
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On today's date, an unannounced Case Management-Other inspection was conducted by Licensing Program Analyst (LPA) Emiko Bell in order to deliver an amended Substantiated complaint findings report.

Upon arrival, LPA was greeted and let into the facility by Licensee Shereal Williams.

Census: There were six children with licensee and one other staff. Staff-child ratio was met.

The original report was amended in order to add wording onto page 2 and then change the spacing on the remaining pages.

No citations have been issued during today's inspection.

Upon receipt, the Licensee shall post the Notice of Site Visit for 30 consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Licensee Shereal Williams. Appeal Rights were not provided since no citations were issued.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
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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