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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700067
Report Date: 05/24/2022
Date Signed: 05/24/2022 01:11:38 PM


Document Has Been Signed on 05/24/2022 01:11 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
367700067
ADMINISTRATOR:WILLIAMS, DEMETRIUS&MAXINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 838-7668
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 5DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Maxine Williams Licensee TIME COMPLETED:
11:48 AM
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Licensing Program Analyst (LPAs) Steven Montoya conducted an unannounced Required 1 Year inspection at the above facility. Upon arrival, the LPA met with licensee Maxine Williams, who guided the LPA to tour of the facility. Individuals residinge in the home include 3 adults (licensee, her husband and Mother in law) and 4 minor children (15 twins 14, 12 child). Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Monday through Friday 6:00 a.m. to 6:00 p.m.

The Home is set up as follows:
This is a single story house with 6 bedrooms, 4 bathrooms, kitchen/dining room, family/daycare room, living room, and attached garage. Per Licensee the living room, and family room/kitchen, 1 bathroom are utilized for the family child care activity area. Per licensee off-limit areas of the home is the all bedrooms, master bathroom, laundry room, and garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air and heat and ventilation.

Main Area: Main care will be conducted in the living room. There is a security gate located prevents children from accessing kitchen.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2022
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Family room/ Daycare area: In the Family room which is the designated playroom, LPA observed age-appropriate toys and furniture for the children. A small table was observed with a total of eight chairs. Several plastic storage bins were observed in which games and toys are stored for the children. There are games and books on the premises of this facility. There are mats on the floor that have educational/learning activities on them. The mats were observed to be in good condition. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris.

Facility Roster: LPA obtained a copy of the Child Care Facility Roster. Per Licensing Information System were current.
· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The facility roster is current. there are current facility earthquake/fire drills documents observed during the time of this inspection.

The following information was discussed with the licensee:


ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2022
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ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.


ü Licensee 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

ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

ü Criminal Record Statement: 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.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2022
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Family Room: In the family room a fireplace was observed that was properly screened via mirror glass doors. However, the glass door needs a repair to make the fireplace is inaccessible to children. In the family room, there were additional toys observed to be in the room stored on cubbies.

Kitchen The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). LPAs inspected the kitchen and observed that all lower cabinets and drawer have child proof latches that are in good condition.


Backyard: The backyard was inspected; the backyard is grass landscaping surrounded by vinyl fencing. Children have access to the backyard. LPA's observed, a plastic kid's slide, several fruit trees, a basketball hoop with other age appropriate toys. LPAs did not observe a swimming pool or bodies of water on the premises. LPAs also observed a big playhouse. It is not for daycare child. Licensee will ensure that children are always supervised while outside in the backyard. There is no body of water on the premises.

The Licensee states the off-limit areas of the home are the bedrooms all (1,2,3,4,5, 6) and bathroom #2, the garage, and laundry room.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2022
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Others:
AC/Heating Unit was observed. AC/Heating Unit is located on the right side of the home it accessible to children via barrels blocking access the unit.
Napping: Children will nap in the designated nap areas with adult supervision. Licensee stores napping equipment in the bedroom near the front door entrance. Per licensee children nap in the living room. There are 9 cots and 1 playpen.

The First Aid kit is located in the living room inaccessible to children.

Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher and located in the kitchen inaccessible to children.


Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.

Bodies of water: There are no bodies of water in the home.

Medications and cleaning solutions are stored in locked cabinets in the off-limits area (Master Bedroom).

Weapons or Firearms: Per licensee, there are 3 firearms. LPA did not observe any weapons or firearms which are locked away in the safe. Licensee was reminded that the fires arms must be separate from the ammunition. Licensee was receptive.

Transportation: The licensee will transport daycare children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2022
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Incidental Medical Services (IMS): 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. The Licensee will not be providing medication to children.

Documentation:
· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (04/2023) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Immunization: The licensee has the required immunization. The licensee provided a written statement declining the influenza vaccination.
· Mandated Reporter Training: The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and need to renew by 02/269/2022
· Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license with an expiration date of 07/25/2023. Licensee has valid vehicle insurance with the expiration date of 01/11/2022 and 6/11/2022 and vehicle registration dated 07/22/22.
· Child files: LPA observed 3 children files contained all required licensing documents.

· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 09/03/2021 .
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 05/24/2022
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The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day 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.

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.


n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

No Deficiencies cited:



Exit interview conducted and report was reviewed with the licensee Maxine Williams.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
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