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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500318152
Report Date: 02/20/2020
Date Signed: 02/20/2020 02:47:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WILLIAMS, PATTIFACILITY NUMBER:
500318152
ADMINISTRATOR:WILLIAMS, CLAUDE/PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 521-5889
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 9DATE:
02/20/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Patti WilliamsTIME COMPLETED:
03:10 PM
NARRATIVE
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On 02/20/2020, Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced annual inspection. LPA was greeted by Licensee Patti Williams who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Present during today’s inspection were nine (9) children and one assistant. Rooms accessible to children in care are the living area, kitchen, day care room, and bathroom. Days and hours of operation are Monday – Friday; 7:00AM to 6:00PM.

No pets were observed in the home. There are no bodies of water on site. There is a working carbon monoxide detector in the home. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home. LPA observed that there are no working smoke detectors or a 2A10BC fire extinguisher in the home. Licensee stated they were taken down recently and she does not know where they were put. Licensee stated she will purchase a 2A10BC fire extinguisher and smoke detectors immediately.

LPA observed a storage room connected to the day care room which was not made inaccessible to children in care. There was a curtain hanging which separated the storage area from the day care room. LPA observed a helium tank and paint cans in the storage room. LPA also observed items such as toothpaste, hair spray, and perfumes labeled “keep out of the reach of children” in the bathroom the children use. Licensee immediately moved bathroom items to an inaccessible area to children. LPA also observed a cordless drill in the kitchen on top of a box, at about knee height to LPA, which was accessible to children in care. Licensee immediately moved cordless drill to an inaccessible area to children.

There is a working telephone and number was verified. Adequate supervision is being provided during this visit. The backyard is made inaccessible to children in care by door lock. Capacity as specified on the license is being maintained. Licensee has a current roster of the children.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WILLIAMS, PATTI
FACILITY NUMBER: 500318152
VISIT DATE: 02/20/2020
NARRATIVE
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Upon review of facility files, LPA observed five children’s files were missing licensing forms and documentation of immunizations. Licensee stated she had given the files back to the parents to update their information.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care.

Licensee is aware that children are never to be left in parked vehicles. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if she provides these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D). Site Visit Notice posted on the parent board. Exit interview was conducted with Patti Williams. Licensee was provided a copy of appeal rights.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) was given to licensee.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WILLIAMS, PATTI
FACILITY NUMBER: 500318152
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2020
Section Cited

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Operation of a family child care home: The home shall be free from ... conditions which might endanger a child. Safety precautions shall include ... The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement was not met as evidenced by:
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Based on LPA's observations and interview with Licensee, Licensee did not ensure there were working smoke detectors and a 2A10BC fire extinguisher as required by the Fire Marshal. This poses an immediate risk to the health, safety, and personal rights of children in care.
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WILLIAMS, PATTI
FACILITY NUMBER: 500318152
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2020
Section Cited

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Operation of a family child care home: Poisons, detergents, cleaning compounds ... and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by:
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Based on LPA's observations and interview with Licensee, Licensee did not ensure hazardous items were made inaccessible to children in care. This poses a potential risk to the health, safety, and personal rights of children in care.
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Licensee stated she will put up a safety gate between the day care room and the storage room which will make the storage room inaccessible to children in care by POC due date, 03/13/2020.
Type B
03/13/2020
Section Cited

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The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement was not met as evidenced by:
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Based on LPA's observations and interview with Licensee, Licensee did not ensure all children's files were updated with licensing forms and documentation of immunizations. This poses a potential risk to the health, safety, and personal rights of children in care.
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4