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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012333
Report Date: 03/15/2022
Date Signed: 03/15/2022 03:01:01 PM

Document Has Been Signed on 03/15/2022 03:01 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
198012333
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
03/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Licensee - Angela WilliamsTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced annual inspection to the above facility on 03/15/2022. LPA arrived at the facility at 12:35PM and met with Angela Williams, who guided analyst on a tour of the facility. Per Licensee, there are 7 children that are currently enrolled. There were 5 children present upon arrival (2 infants and 3 school age). LPA observed A2 arriving at the facility at 1:40 PM

This is a one story home which consists of three bedrooms, two bathrooms, kitchen, dining room, two living rooms, front yard (fenced), side yard (fenced), backyard (fenced) and detached garage.. The off limit areas include master bedroom, master bathroom, backyard, and detached garage. Per licensee, she is currently not utilizing outdoor play area temporarily due to the weather.

The main care area is located in the bedroom. LPA observed sleeping cots, a wall mounted television, child sized table, child sized chairs, age appropriate toys and materials. Three children were observed napping in the main care area. A second bedroom was observed to have a wall mounted television, a full sized bed, bedroom furniture, and a Babytrends Pack and Play. The bathroom designated for children in care was observed to be clean and free of defects. The living room was observed with a fireplace that has been covered and locked making it inaccessible for children in care. Laundry detergents were observed to be kept in a cabinet above the washing machine making contents inaccessible to children in care. Additional cleaners and kitchen knives were observed to be locked in the hallway closet. A dining table and chairs were observed in the dining room. Per licensee, meals are taken in the main care area where the child sized chairs and table can be utilized. A television and sectional couch were observed in the second living room. Per licensee, isolation area for children showing signs of illness will be located in the second bedroom. LPA observed the outdoor play area to have additional age appropriate toys, materials, tricycles, and a basketball hoop. Per licensee, when children utilize the outdoor play area, a baby gate is used to separate the side yard from the off limits backyard area. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2022
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 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198012333
VISIT DATE: 03/15/2022
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were observed to be posted. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Individuals who reside in the home were noted and discussed. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Licensee states that there are no firearms stored in the home

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,
comfort, and cleanliness. There is telephone service via a landline. Per Licensee, the home is equipped with central heating and air conditioning. The valve on 3A-40BC fire extinguisher indicates fully charged and was observed with a purchase receipt dated 03/11/22. Smoke and carbon monoxide detectors were tested and are operable.

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.

LPAs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. LPA did not observe any objects that can pose a danger to children in care. No bodies of water were observed on the premises. A dog was observed in the off limits backyard.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 10/2022 LPA observed that the Licensee to have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. File review was observed to have proper mandated immunization records. Children’s records were reviewed, including emergency
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198012333
VISIT DATE: 03/15/2022
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information and were observed to be complete. A current children’s roster was available for review. LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov.

Incidental Medical Services (IMS):
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.
A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Angela Williams.


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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
LIC809 (FAS) - (06/04)
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