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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000052
Report Date: 08/03/2022
Date Signed: 08/03/2022 11:59:50 AM


Document Has Been Signed on 08/03/2022 11:59 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:WILLIAMS, ARNELLAFACILITY NUMBER:
384000052
ADMINISTRATOR:WILLIAMS, ARNELLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 822-0509
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:12CENSUS: 4DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Clarissa WilliamsTIME COMPLETED:
11:09 AM
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On August 3, 2022, Licensing Program Analyst (LPA) Sheran Lo arrived at the facility to conduct an unannounced Annual Inspection on this day and met with the Helper (Licensee's daughter) Clarissa Williams. Purpose of the inspection was explained. Present there were 4 children in care with Helper. Licensee was operating in compliance to the required licensed capacity and ratio limits as of today. Per Licensee, the two story house is owned and living at home are Licensee and so. LPA verified the background check clearance of the adults working or living in the home. The hours of operation are: M-F, 8:00 AM – 6:00 PM. Meals are not provided by facility.

Daycare areas: Ground Level: Living Room, Garage, Bathroom, and Backyard. Off Limit areas: All Second level Bedrooms, Living Room, Dining Room, Bathroom, and Kitchen. The stairs going to upper level of the home from child care have been properly barricaded. LPA and Licensee inspected the entire child care area for Health and Safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There was a separate carbon monoxide and smoke detector in the home. LPA performed the tests to check the functionality of the detector. A fire extinguisher of size 2A10BC or bigger was also available in the home. First Aid kit is fully stocked and accessible. There are no firearms or weapons in the home. There are no bodies of water and no pets in the home.

LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation. LPA observed that there is a variety of age appropriate toys, books and other learning material available in the home for the children in care. Electric outlets have been secured with child protective covers, and a working phone is on site. Per Licensee, Discipline policy is redirection or communicate about positive behavior practice.

All posting requirements are met and posted near the child care entrance. Licensee has current and valid CPR and First Aid card expiring on 7/2024.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran LoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: WILLIAMS, ARNELLA
FACILITY NUMBER: 384000052
VISIT DATE: 08/03/2022
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LPA reviewed facility records including all children's files present today. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the helper Clarissa Williams.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran LoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
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