<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700009
Report Date: 05/19/2023
Date Signed: 05/19/2023 02:01:05 PM

Document Has Been Signed on 05/19/2023 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WILLIAMS, ASHLEYFACILITY NUMBER:
015700009
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
05/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Ashley WilliamsTIME COMPLETED:
02:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 19, 2023, Licensing Program Analyst (LPA) Simerjit Kaur met with licensee Ashley Williams for an unannounced case management visit for a capacity increase. Present during the inspection are 3 infant age and 3 preschool age children and licensee's fingerprint cleared mother Jean Williams. Hours of operation for child care are Monday through Friday, 8:00am to 5:00pm. The facility is a one story house. The following was observed during today’s inspection:

All documents have been received for the increase of capacity application. The fire clearance for a capacity of 14 children was performed by the Livermore Fire Department on 05/17/2023 and was granted approval. Facility has a fully charged 2A10BC fire extinguisher. Fire alarm, smoke and carbon monoxide detectors were tested. The licensee has a hired and fingerprint cleared/associated adult assistant. The licensee was reminded that the assistant must be present at all times when there is more than 8 children in attendance. When the assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

The home is recommended for a large family child home.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted licensee Ashley Williams.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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 2
Document Has Been Signed on 05/19/2023 02:01 PM - It Cannot Be Edited


Created By: Simerjit Kaur On 05/19/2023 at 01:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: WILLIAMS, ASHLEY
FACILITY NUMBER: 015700009

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited
CCR
102425(j)(2)

1
2
3
4
5
6
7
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:
This requirement is not met as evidenced by: There are 3 infant age children in care, and sleep logs were not maintained. Based on record review, the licensee did
1
2
3
4
5
6
7
Licensee will ensure to record sleep logs for all infants up to age 24 months and have avialable for deparment to review. Licensee will send copy of sleep logs to LPA by 5/26/23.
8
9
10
11
12
13
14
not comply with the section cited above in that licensee does not have sleep logs, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Jason Jang
LICENSING EVALUATOR NAME:Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2