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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017681
Report Date: 06/06/2023
Date Signed: 06/06/2023 11:54:14 AM


Document Has Been Signed on 06/06/2023 11:54 AM - 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
198017681
ADMINISTRATOR:WILLIAMS, VICKYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 628-4070
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 6DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Vicky Williams, LicenseeTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced required 1 year inspection to the above facility. LPA met with Vicky Williams, Licensee who guided analyst on a tour of the inside of that facility and due to Licensee stating she is sick tour of the outside was given by Licensee assistant Artrea Williams. Also present during this inspection, is Ruby Jones, Licensee’s Assistant. Roster shows there are 22 children enrolled and 6 children were present during the inspection (5 children & 1 infant). Current hours are Monday to Friday 6am to 6pm, however Licensee is available for care 24 hours, 7 days a week if needed.
This is a one-story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, den (child care room), nap room/bedroom, living room, garage, wash room, front yard and backyard (fenced). The children use the bathroom in the hallway. Per licensee, areas off limits to children and parents include: three bedrooms, dining room, kitchen, living room, garage, and front yard. The licensee provides food for children in care.

All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service (updated during inspection), ventilation and heating (central). The following was observed and reviewed during this inspection.

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 6/6/23 during inspection.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198017681
VISIT DATE: 06/06/2023
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Smoke and carbon monoxide detectors were tested and are operable. The 2A10BC fire extinguisher was last purchased on 10/24/2022. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds and medication are under the locked kitchen cabinets and was inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in nap room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Currently licensee has 1 infant enroll. Infant is about to be 2 years old and sleeps on a cot. LPA reviewed the following is case Licensee has new infants in the future: napping equipment can not block entrances or exits. Infant mattresses were need to be firm with tightly fitted sheets. Playpens or cribs can not have any loose object, bumpers, objects hanging, or objects attached. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. 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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA's observed that the outdoor yard has toys and other materials for children to play with. LPA's did not observe any objects that could be hazardous to children in care. There are no bodies of water at the facility.



Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunizations Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form was given during inspection and the sleep log (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months).
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198017681
VISIT DATE: 06/06/2023
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Staff records were reviewed for approved Pediatric First Aid and CPR certification, which expires on 12/18/2023;, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate and expires on 11/04/2024.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

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/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.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.



Based on the LPA's observations and records review no deficiencies will be cited today 6/06/23. A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and explained. Exit interview conducted and report was reviewed with the Licensee assistant A. Williams
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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