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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700067
Report Date: 05/24/2019
Date Signed: 05/24/2019 11:45:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
367700067
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
05/24/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Maxine & Demetrius WilliamsTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Neal met with Applicants, Maxine & Demetrius Williams today for the purpose of conducting a pre-licensing inspection for a small family child care home. Home consists of 6 bedrooms, 4 bathrooms, kitchen, living room, family room, dining area and backyard. Parents will enter child care room through the front door. Family members residing in the home include 3 adults (Applicant's and one applicant's mother) and 4 children. Incidental Medical Services (IMS) policy was discussed.
Home was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that are inaccessible to children. Fireplace is located in the off-limits family room and is screened. Child care activities are to be conducted in the living room and dining room areas. Children will use the bathroom down the left hallway. Applicants state that if necessary, the bathroom on the right side (across from kitchen) will be available for use. Garage and laundry room observed with child locks. No child care will be conducted in the garage. The entrance to home has a high hook latch. Off limits areas include all bedrooms (child safety knobs observed) and other 2 bathrooms. Exception made for the bedroom at the end of the hallway on the right side of home. Per applicants, bedroom at the end of the hallway will be used only for ill children. Kitchen is accessible to children. Cleaning compounds and detergents are kept in child locked cabinet under the kitchen sink. Knives are kept in a container in a high, child locked kitchen cabinet. Pantry contains child safety knob. Medications are made inaccessible by child lock in a high kitchen cabinet. Parent board was observed.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2019
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Applicant shall conduct fire/earthquake drills every 6 months and document (optional form provided). A Child Roster form was provided and explained in detail. There are mats and a pack and play available for napping children. There is a large fish tank in the dining room area. Cabinets underneath have magnet locks and there is a combination lock for inaccessibility. There is no pool or spa on the premises. Children will play in the backyard. There is a padlocked gate that separates child care play area from the rest of the backyard. LPA observed grass and concrete for active play. There is 1 large dog. The dog run is located on the off limits portion of the backyard. There is also a garage (key locked) used for storage at the far end of the off-limits portion of the backyard . No childcare activities are conducted there.
LPA observed firearms stored in a separate locked area from where ammo is stored. Both are made inaccessible in locked safes and stored in an off limits area of the home. The required fire extinguisher, carbon monoxide detector and smoke detector are in operable condition. The facility has central AC and heat. Applicants have current pediatric CPR/First Aid certification, set to expire 11/2020. An emergency supply bin was observed and is located in the garage. Preventative Health and Safety with child nutrition training was completed by both applicants on 10/20/2018. Mandated Reporter training for Child Care was completed on 10/18/2018. Applicants were reminded that Mandated Reporter training must be completed every 2 years.
The following was discussed with the Applicant:
Mandatory Forms for the children’s files and provider’s files, requirements for fire drills, earthquake drills and documentation for both. Roles and responsibilities of being a mandated reporter were reviewed. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2019
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Licensing must have the facility’s phone number at all times; if the phone number is changed, Licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family child care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

To receive the quarterly updates on Community Care Licensing by email, please send your request to: Childcareadvocatesprogram@dss.ca.gov

Applicant was advised to review Quarterly Updates which includes past information on: SB 277 - requires all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles and TB clearance.



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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2019
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Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents (observed). Handouts for Seat Belt Safety, SIDS, Shaken Baby Syndrome were discussed. Licensee was given Safe Sleep Concepts handout and informed to regularly visit www.ccld.ca.gov for upcoming regulations.

Applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.



Before licensure the following must be completed:
1) Applicants will make air conditioning unit in backyard inaccessible to children.

Once correction has been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Applicant is advised that all corrections are due within 30 days or the application may be withdrawn.

Exit interview was conducted a copy of this report was printed and given to applicants.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
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