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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016150
Report Date: 11/17/2021
Date Signed: 11/17/2021 02:39:00 PM

Document Has Been Signed on 11/17/2021 02:39 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:
198016150
ADMINISTRATOR:WILLIAMS, ROSALINDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 462-9958
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
11/17/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Rosalind Williams - LicenseeTIME COMPLETED:
02:40 PM
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This is an unannounced Case Management Inspection visit conducted on 11/17/2021 1:25 PM by Alicia Bailey Licensing Program Analyst (LPA). LPA met with Licensee Rosalind Williams regarding the usual incident report received in the office on 10/26/2021. LPA and Licensee Williams toured the facility, at the time of the inspection all ratios were in compliance.

The report stated that on 10/26/2021 one person (child # 1) tested positive for Covid-19. Licensee Williams receive positive test result on 10/25/2021. Licensee Williams contacted Licensing Department, clean and sanitize the facility .The notice was posted at the facility and sent out to the parents. The child # 1 tested again and receive a negative test result on the second covid-19 test.

LPA Bailey advised Licensee Williams to contact the Los Angeles County Public Health Department, with the link that was provided via email from LPA Bailey.

Based on today’s inspection, and interview conducted, the facility followed the appropriate reporting requirements, Notified Parents, no follow-up is necessary regarding the incident. Licensee Williams followed the required protocol for reporting requirements" as the incident was reported to Child Care Licensing. It does not appear this incident was the result of a Title 22 violation and the facility followed the appropriate regulations to care for the children in care. No deficiencies were cited on this date.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
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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