198012333-4-5-2023-54-CC-RDEO-CQLUYZ-20230405160047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012333
Report Date: 04/05/2023
Date Signed: 04/05/2023 04:00:55 PM

Document Has Been Signed on 04/05/2023 04:00 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 CARE		FACILITY NUMBER:	198012333
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 7	CENSUS: 3	DATE:	04/05/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Licensee - Angela Williams		TIME COMPLETED:	04:20 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	Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management inspection to the above mentioned address on 04/05/23 at 2:50 PM. LPA met with licensee, Angela Williams, who guided LPA on a tour of the home. LPA observed 1 adult and 5 children present during inspection. LPA observed 1 child being picked up at 2:35 PM and another child being picked up at 2:50 PM. Individuals residing in the home have been noted and discussed. The licensee is requesting a capacity increase to her small capacity family childcare home license. Per licensee, operation hours will be Monday through Friday 6:30 AM - 6:00 PM. Licensee states she will care for children 0 to 13 years old. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 3 bedrooms, 2 bathrooms, living room, family room, dining room, kitchen, laundry area, front yard and backyard (fenced). Per licensee, the backyard is temporarily off limits due to a garage remodel. 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. LP a observed sleeping cots located in closet in the hallway. LPA observed cleaning supplies and pointy/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 section 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 (page 1 of 3)

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)

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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

NARRATIVE

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observed with perimeter fencing, grass, and Easter decorations. Per licensee, outdoor play equipment is stored in the backyard and taken to the front yard for outdoor play time. Licensee states she provides food for children in care. Licensee also understands that children bringing food from home shall be labeled and properly stored. 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.

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

NARRATIVE

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The licensee's Pediatric First Aid and CPR expires on 08/25/24. LPs 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. A first aid kit was observed on the wall in the laundry area.

Incidental Medical Services (IMS):
This facility may provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov

Applicant is requesting a capacity increase to a large family child care. Fire clearance was approved on 02/06/23. A large family childcare license may be granted upon Licensing Program Manager (LPM) Approval. Once licensed, the licensee is required to comply with the terms and limitations stated on the license.

Prior to approval of a large family child care license, the following corrections must be observed:

-Permission letter must be obtained from the re-location sites indicated on the LIC610A - Emergency Disaster Plan.
-Negative TB test needed for S2
-EMSA certified Pediatric First Aid / CPR training certificate must be observed for S2
-Mandated Reporter AB1207 compliant training certificate for S2 must be observed

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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