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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012333
Report Date: 04/05/2023
Date Signed: 04/05/2023 03:59:47 PM

Document Has Been Signed on 04/05/2023 03:59 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 S WEST, 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: 3DATE:
04/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensee - Angela WilliamsTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required one year inspection to the above facility on 04/05/23. LPA arrived at the facility at 12:50 and met with Licensee, Angela Williams, who guided analyst on a tour of the facility. Also present during this inspection was S2. Per Licensee, there are 7 children that are currently enrolled. There were 5 children present upon arrival. S2 was also present with her infant child. LPA observed 1 child being picked up at 2:35 PM and another child being picked up at 2:50 PM.

This is a one home which consists of 3 bedrooms, 2 bathrooms, kitchen/dining room, living room, family room, a detached garage, front yard and backyard (fenced). Per licensee, the backyard is temporarily off-limits due to a garage remodel project.

The main care area is located in bedroom 1. LPA observed sleeping cots, age appropriate toys, art supplies, a wall mounted television, child sized tables, child sized chairs and educational posters. The living room was observed with two couches and a television. A fire place was observed to be locked in the living room. Bedroom 2 was observed with a twin sized bed, a dresser, ceiling fan and wall mounted television. LPA
observed sleeping cots located in the hallway closet. LPA observed cleaning supplies and pointed/sharp objects stored in a locked closet in the hallway. The closet was observed with a pad lock and a latch. The bathroom was observed with an operable sink, toilet and faucet. The dining room was observed with a dining table and chairs. The family room was observed with an entertainment center, television and sectional couch. The kitchen was observed to be clean and free of defects. No cleaning supplies or sharp objects were observed to be accessible in the kitchen. The master bedroom was observed with a bed, bedroom furniture and a fireplace. The fireplace was observed to be locked with a U-Lock. Per licensee, children showing signs of illness will be separated into the master bedroom while the child awaits parent pick up. The front yard was observed with perimeter fencing, grass, and Easter decorations. Per licensee, outdoor play equipment is
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198012333
VISIT DATE: 04/05/2023
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stored in the backyard and taken to the front yard for outdoor play time. Licensee states she provides food for children in care. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the hallway next to the locked closet. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. No bodies of water were observed in the back yard play area. There is a pet dog kept in the off-limits section of the backyard. 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.

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 land line. Per Licensee, the home is equipped with central heating and air conditioning. Day care area was observed with safe toys, play equipment and materials. The licensee understands that storage areas for poisons must be locked, not just inaccessible. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced in 04/2022, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. Licensee states that there are no firearms or weapons stored in the home.

LPA discussed the safe sleep regulations with license 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

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198012333
VISIT DATE: 04/05/2023
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The licensee's Pediatric First Aid and CPR expires on 08/25/24. LPA observed that the Licensee has 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 information and were observed to be complete. A current children’s roster was available for review.

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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov. LPA also discussed and provided the Provider Information Notices (PINS) on Recently Approved Safe Sleep Regulations in Effect: PIN 20-24-CCP.

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: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC809 (FAS) - (06/04)
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