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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 05:36:34 PM

Document Has Been Signed on 07/02/2024 05:36 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: 14CENSUS: 4DATE:
07/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Debra WilliamsTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 7/2/2024 at 4:00 pm, Licensing Progam Analysts (LPAs) Claudia Kam and Andrea Carter conducted an unannounced case management visit to the above mentioned facility. LPAs arrived at the facility and was met by licensee, Debra Williams who guided analysts on a tour of the facility. LPAs observed the licensee and 4 child in care at time of visit. The facility was observed to be clean and free of defects.

The purpose of this visit is to provide the licensee with the decision order for uncleared adult and consult with licensee regarding the decision of non-exempted adult per court order. LPAs provided licensee with a copy of the decision order. Per licensee 3 adults live in the home her daughter, husband and herself. LPAs discussed the decision order to ensure she understands that the individual’s exemption was denied and he cannot reside in the home or visit while children are in care.


An exit interview was conducted and report was reviewed with 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
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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