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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215210
Report Date: 10/29/2020
Date Signed: 10/29/2020 11:46:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:WILLIAMS FCCFACILITY NUMBER:
426215210
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
10/29/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Veronica WilliamsTIME COMPLETED:
11:50 AM
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On October 29, 2020 at 11:07 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an announced Case Management inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA met with licensee Veronica Williams and discussed the nature and purpose of the inspection. The tele-inspection was initially started by phone and switched over to be conducted via Zoom. During this tele-inspection, the licensee provided LPA a tour of the home inside and out. Licensee had no children in care at the time of the inspection.

Licensee applied to the Community Care Licensing (CCL) requesting to become a large family childcare facility. The licensee uses the living room, garage, one restroom, and back yard for their day care. On October 23, 2020 the Lompoc Fire Department inspector conducted a fire inspection. The facility received a fire clearance approval for the large family childcare. A 2A10BC fire extinguisher was observed mounted on the wall with a service date of 06/03/2020. Pediatric CPR and First-Aid certification is current until 02/27/2021. LPA observed that the licensee has a trampoline in the back yard with a security netting. LPA advised licensee to follow all manufacture warnings, age requirements, and instructions. Licensee advised to not leave children unattended when the trampoline is being used. Licensee has completed all required licensing requirements to become a large family childcare.

Facility license will be a large family childcare effective today, October 29, 2020 for a capacity of 14 children.

A copy of this report was reviewed and provided to the licensee. Licensee agreed to receive a copy of report via email and voiced understanding that the read receipt confirmation from email will be in lieu of their signature once she receives the report. LPA requested licensee to send a copy of signed report for records.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020
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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