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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841644
Report Date: 06/20/2019
Date Signed: 06/20/2019 02:06:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
334841644
ADMINISTRATOR:WILLIAMS, BONITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 922-9308
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:14CENSUS: 9DATE:
06/20/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Bonita WilliamsTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Joanne Domingo arrived at the facility to conduct a Case Management visit. LPA Domingo met with Licensee, Bonita Williams, conducted census and discussed the purpose of the visit.

LPA Joanne Domingo attempted phone calls to the phone # on file, 951-922-9308, however the phone number is not in service. Licensee provided an updated cell phone number 951-796-088.


NO DEFICIENCIES WERE CITED DURING THIS VISIT.

An exit interview was conducted, a Notice of Site Visit posted and a copy of this report was provided to Licensee on this date.

This report shall be made available for the public for the next years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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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