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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364803632
Report Date: 12/14/2022
Date Signed: 12/14/2022 09:25:07 AM


Document Has Been Signed on 12/14/2022 09:25 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
364803632
ADMINISTRATOR:WILLIAMS, APRILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 797-7846
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:14CENSUS: 3DATE:
12/14/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Licensee April WilliamsTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA), Susan Brewer, arrived at the facility to conduct a case management regarding a Decision & Order dated 12/08/2022. LPA was greeted by the Licensee April Williams and granted access into the home. LPA conducted census and present were the licensee and 1 adult resident. A. Williams, stated that she received a copy of the Decision & Order but had not reviewed it. LPA discussed the Decision & Order with April Williams, and the licensee stated they will comply with the ORDER.

LPA toured the facility inside and out to ascertain whether or not, MR. NOAH J. WILLIAMS was present in the facility. LPA did not observe Mr. Noah J. Williams, at the facility. Furthermore, Licensee April Williams, stated that her son Noah J. Williams, was not present in the facility, has not been at the facility and resides at a separate address.

LPA S. Brewer, provided and discussed with Licensee April Williams, the LIC995B Family Child Care Home Addendum to Notification of Parents' Rights form (Regarding Removal/Exclusion). A. Williams, was advised that the parents of all the children currently enrolled and receiving child care, and future enrolled clients, must be given the LIC995B form to read and sign. Licensee April Williams was informed that the LIC995B Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Removal/Exclusion) must be given to all client parents while the facility is licensed by Community Care Licensing Department (CCLD). Licensee Licensee April Williams, stated that they understand the document, the requirement to keep a record of the LIC995B and the licensee agreed to comply.

The licensee April Williams, further understands that NOAH J. WILLIAMS is prohibited from employment in, presence in, and contact with clients of any facility licensed by the Department and is also prohibited from holding the position of member of the board of directors, executive director, or officer of the licensee, or of any facility licensed by CCLD. An exit interview was conducted, a Notice of Site Visit posted, and a copy of this report was provided to April Williams.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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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