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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500318152
Report Date: 10/13/2020
Date Signed: 10/15/2020 10:54:42 AM

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: 11DATE:
10/13/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Patti WilliamsTIME COMPLETED:
04:00 PM
NARRATIVE
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On 10/15/2020, Licensing Program Analyst (LPA) Candis Rodriguez conducted an inspection to amend the Case Management-Deficiencies report dated 10/13/2020. The purpose of the amendment was to indicate that a civil penalty was assessed for the deficiency cited on 10/13/2020.

On 10/13/2020, Licensing Program Analysts (LPAs) Candis Rodriguez and Stefanie Galvan conducted a complaint inspection at facility. LPAs met with Licensee Patti Williams, explained purpose of inspection, toured the facility and took a census.

During inspection, LPAs observed various household cleaners under the kitchen sink which were accessible to children in care. LPAs also observed paint cans and mouse droppings under the kitchen island. Licensee immediately removed all household cleaners from underneath the sink and removed the paint cans from under the kitchen island. Licensee moved these items to an area inaccessible to children in care. Licensee stated she will clean underneath the kitchen island and schedule pest control to come assess the entire home as a precaution.

Upon review of Licensee’s compliance history, LPA observed Licensee was issued a deficiency within the last 12 months for hazardous items being in an area accessible to children.

Per the California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiencies are found: See LIC 812-D. An exit interview conducted with Licensee Patti Williams.



On 10/13/2020 an immediate civil penalty of $250 was warranted and was assessed for the day of 10/13/2020.

A Notice of Site Visit was posted on parent board. Appeal rights left with Licensee.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020
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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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: 10/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2020
Section Cited

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Operation of a family child care home: Poisons, detergents, cleaning compounds...and other dangerous 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 LPAs' observations and interview, 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. Civil Penalty assessed for repeat violation within 12 months.
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Licensee stated she will cean under the kitchen island. Licensee scheduled pest control to assess her home this week, and stated she will provide receipt after her home is serviced, by POC due date.

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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: 10/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2020
LIC809 (FAS) - (06/04)
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