198018570-6-17-2025-54-CC-ACAN-DHQRGN-20250617130101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018570
Report Date: 06/17/2025
Date Signed: 06/17/2025 01:01:45 PM

Document Has Been Signed on 06/17/2025 01:01 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	WILLIAMS FAMILY CHILD CARE		FACILITY NUMBER:	198018570
ADMINISTRATOR/ DIRECTOR:	WILLIAMS, ASHLEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 346-7726
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90061
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 8	DATE:	06/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	WILLIAMS, ASHLEY / LICENSEE		TIME VISIT/ INSPECTION COMPLETED:	01:10 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) Ashley Calderon conducted an unannounced random / annual inspection. LPA met with Staff Assistant Jacqueline Brown who allowed LPA entrance into the facility. Shortly after LPA met with Licensee Ashley Williams, LPA discussed purpose of today's visit. Upon arrival LPA observed the Licensee and cleared assistant caring for seven children (3 infants) . All adults /residents associated with the facility were noted and fingerprinted cleared. Facility hours of operations are Monday - Friday 6am-6pm. . All areas identified on the facility sketch were inspected. This is a single story home consisting of 5 bedrooms, two bathrooms, kitchen, living room with dining area, front yard, middle patio area/yard, backyard and detached shed. The areas used by children include: living room, dining area, front bedroom, one front bathroom. Off limits areas are: 4 bedrooms, 1 bathroom, front yard, detached shed, and back yard/ patios. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed age appropriate toys and play equipment inside and of the home. No bodies of water observed on premises. Per Licensee, occasionally uses the local park Athens Park. There is a working telephone maintained in the home. Per Licensee has zero pets, no firearms and no day care children are on medications. (Pg 1/ Cont...)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

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 7

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 198018570
	VISIT DATE: 06/17/2025

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
26
27
28
29
30
31
32

LPA observed detergents and cleaning compounds in locked cabinet in the hallway. LPA observed the bathroom under construction start date 6/14/25 (the weekend) and no children in care on the weekend, Licensee reported construction to LPA Calderon, no workers present during visit. Children still have access to the restroom. LPA informed Licensee that poisons must be locked not only inaccessible when present in the home.

The License, Parents Rights poster PUB, and Earthquake Preparedness was posted by the exit/ entrance main door. The children's roster and Disaster drill was current last conducted June 2025. Carbon monoxide and smoke alarm per licensee are interconnected, tested and found operable. At 11:17am Fire extinguisher was observed with service tag June 6, 2024 and not within 1 year of service, picture taken, deficiency cited.

Infants sleep in the day care bedroom, 3 cribs were observed. Cribs used for napping are free of loose items, blankets and no objects with infants during nap time. No infant was at the 0-12 months age to need LIC9227 Individual Infant Safe Sleep Plan, LPA reviewed form.

Facility provides food in care for the children in care. Licensee was reminded if food is brought from children's home to write name of the children and properly store it. Facility will start with the food program soon per licensee.

Staff records and children records was reviewed. Licensee mandated reporter expires 2/18/27 and Licensee assistant did not have mandated reporter certification to provide to LPA Calderon, deficiency cited. Licensee and staff assistant Pediatric first aid and cpr expired on 5/27/25, deficiency cited. Children records were observed at 11:34am Child #1, Child #2, Child #3, 15 min sleep log was not current and during record review observed has time has not been recorded since Feb 2025, picture taken, deficiency cited. At approx child #4 (infant) arrived.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
(Pg 2/ Cont...)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

LIC809 (FAS) - (06/04)

Page: 3 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 198018570
	VISIT DATE: 06/17/2025

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
26
27
28
29
30
31
32

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on today’s visit, Per California Code of Regulations Title 22, the facility was given (5) deficiency, Type B, provided on LIC 809-D.

A notice of site visit was given and must be posted for 30 days and appeal rights provided. Exit interview conducted and report was reviewed with Licensee Ashley Williams.

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

LIC809 (FAS) - (06/04)

Page: 7 of 7

Document Has Been Signed on 06/17/2025 01:01 PM - It Cannot Be Edited

Created By: Ashley Calderon On 06/17/2025 at 12:16 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198018570
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation at 11:17am LPA Calderon - Fire extinguisher was observed with service tag June 6, 2024 and not within 1 year of service, picture taken. The licensee did not comply with the section cited above in [1] out of [1] fire extinguisher which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2025
	Plan of Correction
1 2 3 4	Fire extinguisher will be serviced and service tag updated. Licensee will send LPA Calderon picture of tag by poc due date.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA Calderon record review for staff assistant does not have Mandated Reporter on file, the licensee did not comply with the section cited above in [1] out of [1] certficiate for mandated reporter which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2025
	Plan of Correction
1 2 3 4	Mandated Reporter Certification will be conducted by staff assistant and send a copy to LPA Calderon by poc due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:

	Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

LIC809 (FAS) - (06/04)

Page: 4 of 7

Document Has Been Signed on 06/17/2025 01:01 PM - It Cannot Be Edited

Created By: Ashley Calderon On 06/17/2025 at 12:16 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198018570
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review conducted by LPA Calderon observed Licensee and staff assistant file- Pediatric first aid and cpr expired on 5/27/25, the licensee did not comply with the section cited above in [2] out of [2] staff Pediatric first aid and cpr not valid which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2025
	Plan of Correction
1 2 3 4	Pediatric first aid and cpr will be taken for Licensee and Staff asssistant and will send copy to LPA Calderon by poc due date.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation Child #3 missing file not reviewed, the licensee did not comply with the section cited above in [1] out of [3] child record which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2025
	Plan of Correction
1 2 3 4	Children's record will be submit: LIC282 Affidavit, LIC700 Identification and Emergency Info, LIC627 Consent for Emergency Medical Tratement , LIC955A Parent Rights, and additional children in care LIC9150

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:

	Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

LIC809 (FAS) - (06/04)

Page: 5 of 7

Document Has Been Signed on 06/17/2025 01:01 PM - It Cannot Be Edited

Created By: Ashley Calderon On 06/17/2025 at 12:16 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198018570
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review by LPA Calderon at 11:34am Child #1, Child #2, Child #3 15 min sleep log was not current and during record review observed has time has not been recorded since Feb 2025, the licensee did not comply with the section cited above in [3] out of [3] infant 15 min sleep log which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2025
	Plan of Correction
1 2 3 4	15 min sleep log for (3) infants will be sent to LPA Calderon by poc due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:

	Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

LIC809 (FAS) - (06/04)

Page: 6 of 7