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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700067
Report Date: 08/09/2023
Date Signed: 08/09/2023 03:34:50 PM

Document Has Been Signed on 08/09/2023 03:34 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
PALMDALE CHILD CARE, 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: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
08/09/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Maxine WilliamsTIME COMPLETED:
03:45 PM
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On 8.9.23, Licensing Program Analyst (LPA) Kris Diaz met with the Licensee, Maxine Williams for an unannounced annual/random inspection. The licensee gave the LPA access to the home and guided a tour of the childcare area. People who reside in the home are the licensee, her spouse, her mother-in-law, and 4 minor children (16 twins 15, 13). All three adults have fingerprint clearance. The licensees have the required immunizations against pertussis (TDAP), measles (MMR) and the flu vaccine. At the time of the visit LPA observed 10 childcare children and 2 assistants. LPA reminded licensee that 100% supervision required at all times when children in care. Per the licensee, the large family childcare home operates 6:00am-6:00pm Mon-Fri. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have childcare children who need IMS currently.

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 family daycare room and bathroom in the childcare area are utilized for the family childcare activity area. Per licensee off-limit areas of the home are all bedrooms, master bathroom, laundry room, kitchen, living room, and garage.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds (kept in off-limits area made inaccessible with a safety gate), medicines (kept in off-limits area made inaccessible with safety gate), and hazardous items that can pose a danger to children. Sharp knives are kept in kitchen inaccessible to children. The facility roster is complete and maintained current. Per licensee fire/earthquake drills are kept current. LPA observed current fire/earthquake drills log. The licensee has a large fish tank in the childcare area and no other pets.

Per licensee, there are no weapons or firearms of any kind in the facility.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 08/09/2023
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The LPA did not observe any weapons. Licensee stated all the firearms have been removed from the home. Children nap in the childcare room. Mats and blankets are provided. The required fire extinguisher (2A10BC), smoke detector and carbon monoxide detector are in operable condition. Home has central air and heat. Licensee completed Pediatric CPR/First aid 8/23 and will provide a photo or email of the certificate when available. Co-licensee has current BLS that expires 8/23. Both assistants present have current CPR/First aid certification. Licensee has a first aid kit in the childcare room that is inaccessible to children. LPA observed the parent board and required documents are posted. The licensee has current Mandated Reporter Training that expires 2/24.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. 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 childcare home and in those areas of the family childcare 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.

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.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, licensees, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Licensees must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700067
VISIT DATE: 08/09/2023
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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

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. Handout of Safe Sleep Concepts was given to the licensee.

Licensee 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.

Exit interview was conducted, report was read with and provided to Licensee on this date.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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