376100602-7-8-2021-51-CC-JREG-C4QTYS-20210708150913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100602
Report Date: 07/08/2021
Date Signed: 07/08/2021 03:10:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	WILLIAMS, ELLEN FAMILY CHILD CARE		FACILITY NUMBER:	376100602
ADMINISTRATOR:	ELLEN WILLIAMS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 624-6628
CITY:	RANCHO SANTA FE	STATE: CA	ZIP CODE:	92067
CAPACITY:	14	CENSUS: 0	DATE:	07/08/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ellen Williams		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 7/8/2021 @ 1:00 p.m., LPA, Joelle Redding, met with Applicant Ellen Williams, for the purpose of a Pre-Licensing inspection. Applicant has applied for a change of location on 11/25/20 and received the fire clearance on 6/25/2021. Applicant is also a foster parent through San Diego Youth Services. There are three foster children between the ages of 12 and 17 and Applicant's own three children, ranging in age from 1 1/2 to 6 years old. Applicant is reminded that any child living in the home who is younger than 10 years, counts in her day care census. LPA toured the home. It is a five bedroom, four bathroom home with a 3 car garage. The entry is a coded gate to the driveway. All required forms were posted. There is a working telephone on the premises. LPA did not note any hazardous items accessible to children. The fireplace is secured, the stairs are gated and there are no firearms or ammunition in the home or on the property. There are disassembled recreational bow and arrows, locked independently in the garage and a pool in the backyard, fully fenced with a self-latching gate per regulation. The fire extinguisher size (2A10BC or larger) meets requirements and is fully charged, mounted in the kitchen The smoke detector (located in each room and outside the room) and carbon monoxide detector (located outside of each bedroom) are operational. Applicant’s Pediatric CPR/FA certification with American Red Cross is valid through 2/8/2022. Mandated Reporter Training Certificates are on file for all staff. All adults living or working in the home have been fingerprint cleared and associated and immunization requirements have been met. Control of property was verified. Applicant will be using the following areas for childcare: Living room, front bedroom, kitchen for eating, hallway bathroom and the playground. Off limits areas of the home include: all other bedrooms and bathrooms, the garage and the office. These areas have been made inaccessible with the use of safety gates, latches or locks. The kitchen and bathroom cabinets are latched as well.. Outdoor play area is fully-fenced and equipped with age-appropriate play structures and toys, in good condition. Applicant was reminded of

SUPERVISOR'S NAME: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WILLIAMS, ELLEN FAMILY CHILD CARE	FACILITY NUMBER: 376100602
	VISIT DATE: 07/08/2021

NARRATIVE

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requirements for children’s records, child abuse reporting, unusual incident reporting, immunizations, criminal background clearance procedures and policies, posting requirements. Safe Sleep regulation and forms, and Shaken Baby Syndrome. Applicant was reminded that walkers, exersaucers, bouncy seats, jumpers, drop side cribs and napping portables are not to be used for day care. Garage use and smoking during in or around day care areas is prohibited.

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, an updated Plan of Operation that includes 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. No services are in place currently.

Applicant is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.

The following corrections are required prior to licensure:

1) Remove agave in playground or trim thorns;
2) Remove cobwebs and debris from playground equipment;
3) Secure living room fireplace;

Upon confirmation of the above-referenced corrections and final file review, the change of location will be granted and a new license will be sent for posting.

SUPERVISOR'S NAME: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

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