198017681-10-31-2024-54-CC-ACAN-DAKRUX-20241031132039

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017681
Report Date: 10/31/2024
Date Signed: 10/31/2024 01:20:55 PM

Document Has Been Signed on 10/31/2024 01:20 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	WILLIAMS FAMILY CHILD CARE		FACILITY NUMBER:	198017681
ADMINISTRATOR/ DIRECTOR:	WILLIAMS, VICKY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 628-4070
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 16	CENSUS: 12	DATE:	10/31/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:50 AM
MET WITH:	Licensee / Vicky Williams		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced required 1 year inspection to the above facility. LPA arrived at 9:45am, no answer at the door when ringing the door. LPA called Licensee Vicky Williams and left a voice message. Shortly, after Licensee Vicky Williams greeted LPA Calderon. Licensee Vicky Williams allowed LPA Calderon entrance to the facility. LPA disclosed the purpose of today's visit and provided Licensee with the Entrance Checklist. At 10am, LPA Calderon observed 11 children with Licensee, no additional staff were observed; citation Type A was given. Licensee Williams guided analyst on a tour of the inside and outside of the facility. At 10:10am, Staff Assistant (Staff #1 /S1) arrived at the facility. Individuals presents are fingerprinted cleared. Current hours are Monday to Friday 6am to 6pm, however, Licensee is available for care overnight care, 7 days a week if needed. LPA Calderon consulted with Licensee childcare cannot exceed 24 hour care continuously. This is a one-story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room, den (child care room), nap room/bedroom, living room, garage, front yard and backyard (fenced). Per licensee, areas off limits to children and parents include: three bedrooms, dining room, kitchen, living room, garage, and front yard. The following was observed and reviewed during this inspection: The kitchen was observed, sharp objects are stored in the kitchen cabinet, this area is inaccessible to the children, doors leading to the off limit kitchen remain lock during child care. Per Licensee, provides food to the children in care. (page 1 / cont...)

Valarie Cook	TELEPHONE: (323) 513-3858
Ashley Calderon	TELEPHONE: (323) 981-3350
	DATE: 10/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198017681
	VISIT DATE: 10/31/2024

NARRATIVE

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Laundry area was observed in the off limit area, detergents and cleaning components are stored in high out of reach shelves above the washer and dryer machine.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children inside and outside of the home. Outside was observed to have no bodies of water. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee, there are no firearms or weapons stored in the home and no pets. There are no children that are on medications.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central).

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 10/30/24. Smoke and carbon monoxide detectors were tested and are operable. At 10:04am LPA observed the 2A10BC fire extinguisher; based on service tag the last inspection dated noted is: 10/24/2022. Licensee had an additional fire extinguisher but no receipt provided to LPA to show proof of purchase within 1 year, per Fire State Marshall regulation; citation was given. Fireplace was observed in off limit area.

At 10:10am, Licensee was unable to provide LPA Calderon infant sleep log for infants; Child #1 and Child #2; citation given. LPA during visit observed (2) infants in care.

LPA reviewed (2) staff records; Licensee's records and Staff #1, staff had appropriate records and training's.
Licensee's and Staff #1 mandated reporter training expires 10/2026 and pediatric first aid and cpr expires 10/23/26. (4) children records were review. LPA reviewed Liability Insurance, facility carry's liability insurance bond according to standards established by the state.

(Page 2/ cont...)

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/31/2024 01:20 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198017681
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation LPA Calderon observed 1 staff with 11 children from 10am-10:10am,and per interview with Liensee staff assistant stepped out and will return, the licensee did not comply with the section cited above in [11] out of [11] children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Staff #1 arrived at the facility shortly being notified, making census 11 children and 2 staff. LPA provided Licensee Capacity Regulation chart. Licensee will submit the Declaration from LIC 855 regarding Title 22 Reg on Staffing Ratio and Capacity, Licensee will write a statement on what they learned and what her plan is to stay in ratio compliance by 11/18/24.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/31/2024 01:20 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198017681
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the fire extinguisher was last serviced and inspection tag dated 10/24/2022, the licensee did not comply with the section cited above in [1] out of [1] object-fire extinguisher which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/18/2024
	Plan of Correction
1 2 3 4	Licensee will either buy a new fire extinguisher or get the fire extinguisher serviced. Licensee will send proof of receipt or service tag to LPA Calderon via email poc due date.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation LPA observed blank 15 min sleep logs for Child #1 and Child #2, Interview with Licensee stated unable to locate sleep logs. Based on record review no logs reviewed for infants, the licensee did not comply with the section cited above in [2] out of [2] infant childre, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/18/2024
	Plan of Correction
1 2 3 4	Licensee will start 15 min sleep log and send logs for Child #1 and Child #2 to LPA Calderon via email poc due date.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198017681
	VISIT DATE: 10/31/2024

NARRATIVE

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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.

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 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.

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/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

(Page 3/ Cont...)

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198017681
	VISIT DATE: 10/31/2024

NARRATIVE

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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.

Based on today’s visit, Per California Code of Regulation Title 22, there were deficiencies provided on the LIC 809-D page. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Vicky Williams.

(Page 4/ End of Report)

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC809 (FAS) - (06/04)

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