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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409651
Report Date: 03/17/2022
Date Signed: 03/17/2022 11:51:12 AM


Document Has Been Signed on 03/17/2022 11:51 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:MACWILLIAMS, VIRGINIAFACILITY NUMBER:
434409651
ADMINISTRATOR:MACWILLIAMS, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 961-8577
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94041
CAPACITY:14CENSUS: 4DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Virginia MacWilliamsTIME COMPLETED:
12:10 PM
NARRATIVE
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On 03/17/2022 at 9:30AM Licensing Program Analyst (LPA) Christina Uribe, met with licensee Virginia MacWilliams for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 4 daycare children and the licensee's fingerprint cleared husband, and the licensee is within ratio today. Licensee's adult daughter who does not live in the home was also present today for the purpose of translation between the licensee and LPA. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Mon-Fri 8am-5:30pm.

The home is a single story home with 2 bedrooms, 2 bathrooms, living room, kitchen, dining area, and back yard. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. All on/off-limit areas are consistent with the facility's pre-licensing reports.

The OFF-LIMIT AREAS are the bedrooms, kitchen, dining area & family room and will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the living room and backyard that is used as the main daycare area. At this time the backyard is temporarily off-limits as there is currently efforts to remove trees from the yard. The designated isolation area is the corner of the living room.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone and fully stocked first aid kit. There are no pools, hot tubes or any other bodies of water present at the time of the inspection. Per licensee, there are no firearms on the premises. Facility does have four dogs that are kept away from children in care.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MACWILLIAMS, VIRGINIA
FACILITY NUMBER: 434409651
VISIT DATE: 03/17/2022
NARRATIVE
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 10/09/2022. The licensee is in compliance with the immunization laws. The licensee has not completed the Mandated Reporter Training resulting in a Type B Violation.

The licensee conducts and documents fire and disaster drills twice a year, however, facility has been closed from March 2020-February 2022 and has not yet performed an emergency drill since reopening. Licensee has 5 months to perform and record an emergency drill to remain in compliance with this requirement. All required forms are posted and visible for public review.

At 10:15am LPA Uribe reviewed 4 children’s files and personnel records. One child does not have immunization records in their file resulting in a Technical Violation. Individual Infant Safe Sleep Plans are complete and in child's file. Sleep Charts for sleeping infants were reviewed and within compliance of the Safe Sleep Regulations. There is a current roster available for review. The facility does not have liability insurance and Affidavit Regarding Liability Insurance forms (LIC 282) were reviewed and one child does not have this form signed resulting in a Technical Violation. Staff interview also conducted and documented.



Incidental Medical Services (IMS) policy was discussed and the facility does not have any children with the need for medication to be kept at the facility at this time. 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 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.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 03/17/2022 11:51 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: MACWILLIAMS, VIRGINIA
FACILITY NUMBER: 434409651

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as she does not have certification for Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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Licensee will complete the Mandated Reporter Training (AB 1207) and email a copy of the certification to LPA Uribe at christina.uribe@dss.ca.gov no later than the due date of 04/15/2022.

Please visit mandatedreporterca.com to complete the required training.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MACWILLIAMS, VIRGINIA
FACILITY NUMBER: 434409651
VISIT DATE: 03/17/2022
NARRATIVE
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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.

Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

Violations Cited Today:

  • Type B Violation: Licensee does not have a current Mandated Reporter Training Certification. Please see attached LIC 809D for additional information.
  • Technical VIolation: One child does not have immunization records in their file. Please see attached advisory note for additional information.
  • Technical Violation: One child does not have a signed Affidavit Regarding Liability Insurance form (LIC 282) in their file. Please see attached advisory note for additional information.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Virginia MacWilliams.

Page 3 of 3 ***Report Complete***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6