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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407526
Report Date: 07/02/2024
Date Signed: 07/02/2024 05:27:01 PM

Document Has Been Signed on 07/02/2024 05:27 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
197407526
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, DEBRA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 321-3940
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
07/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Debra WilliamsTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 7/2/24 at 2:00 PM Licensing Program Analysts (LPA) Claudia Kam and Andrea Carter conducted an Unannounced Required 1 year Annual inspection to the above facility. LPAs disclosed the purpose of the inspection and met with Licensee, Debra Williams who guided the LPAs on a tour of the facility.

There are 3 adult living in the home. Two adults in the home were found to have criminal record clearance. There were 4 day care children present during today’s inspection. Licensee states that there are currently 8 children enrolled. The children's roster was reviewed and is current. Licensee reports that the facility’s hours of operation are 24 hours, Monday thru Sunday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Per Licensee, and review of drill log, disaster drill was last conducted on 6/24/24.

This is a two-story home which consists of 4 bedrooms and 2 bathroom, kitchen, living room, and back yard. LPA observed a fireplace in the home that is barricaded by a gate and screen. Areas used by the children include the living room, bathroom, and bedroom 1 and bedroom 2, kitchen and dining room. Bedroom 1 will be used for isolation of sick children. Per Licensee, areas off limits to children and parents include master bedroom upstairs and bedroom 3 in the hallway next to bedrooms 1 and 2. LPAs observed that there is a locked door to the second floor that is kept locked during care hours and hallway bedroom 3 is locked during care hours making it inaccessible to children. LPAs observed doors to be locked at time of inspection.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197407526
VISIT DATE: 07/02/2024
NARRATIVE
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 Main Care Area for day care children will be the open concept kitchen with attached dining room equipped with a secured television and large sofa. The living room is located upon entry to the facility with 3 sofas and a coffee table. Bedroom 1 is used for napping and was observed to be equipped with 2 play yards, bedroom 2 outfitted with a sofa, cubbies and television for the school age children. LPAs observed central air in the home. There is a working telephone maintained in the home, land line and cell phone.

Per licensee, the children will have access to the back yard for outside play. LPAs observed yard has grass and adequate perimeter fencing through-out the property. LPAs observed ride on toys, scooters, age appropriate slide and ground to be free of loose and sharp parts available for the children in the yard and all trees, shrubs, and plants are maintained.



The 2A 10BC fire extinguisher was observed. LPAs checked Smoke and carbon monoxide detectors are in operable condition at time of inspection. LPAs observed First Aid kit kept on shelf in Main Care Area in the kitchen. Licensee provided proof of immunization against influenza, pertussis, and measles during today’s inspection. Licensee has current mandated reporter training with an expiration date of 6/9/22.

—CPR Card valid until: 6/2026

—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs did not observe any bodies of water around the premises at time of inspection. Per licensee, they provide food for children in care. Food preparation area was toured and found in compliance for safety, cleanliness, and proper storage.

LPAs reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the licensee.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197407526
VISIT DATE: 07/02/2024
NARRATIVE
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The following were discussed:

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee Debra Williams was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197407526
VISIT DATE: 07/02/2024
NARRATIVE
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During the exit interview, the Licensee Debra Williams, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on this information the following deficiencies on the LIC 809 D are being cited today 7/2/2024.

LPAs Claudia Kam and Andrea Carter informed licensee Debra Williams that this report dated 7/2/2024 documents 1, Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.



Also, LPA Claudia Kam and Andrea Carter informed the licensee Debra Williams to provide a copy of this licensing report dated 7/2/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Debra Williams.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 07/02/2024 05:27 PM - It Cannot Be Edited


Created By: Andrea Carter On 07/02/2024 at 04:23 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197407526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

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 which poses an immediate health, safety or personal rights risk to persons in care. Daughter does not have clearance in Guardian associating her with the daycare facility.
POC Due Date: 07/12/2024
Plan of Correction
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Licensee will have adult fingerprinted and adult will move out of the home till fingerprints have cleared with the department.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Andrea Carter
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 07/02/2024 05:27 PM - It Cannot Be Edited


Created By: Andrea Carter On 07/02/2024 at 04:23 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197407526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. No proof of purchase available to verify date of purchase of fire extinguisher
POC Due Date: 08/01/2024
Plan of Correction
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Licesee will purchase a new fire extinguisher and provide verification to the department.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Blankets and pillows observed in play yards with infants napping.
POC Due Date: 07/02/2024
Plan of Correction
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Licensee has removed the pillows and blankets during inspection on 7/2/24
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:Denise Gibbs
LICENSING EVALUATOR NAME:Andrea Carter
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 07/02/2024 05:27 PM - It Cannot Be Edited


Created By: Andrea Carter On 07/02/2024 at 04:23 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 197407526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with licensee and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. No sleep log available for review.
POC Due Date: 08/01/2024
Plan of Correction
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Licensee will keep a sleep log and submit a copy of July log to the department.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Andrea Carter
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


LIC809 (FAS) - (06/04)
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