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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400280
Report Date: 12/16/2022
Date Signed: 12/16/2022 11:30:06 AM

Document Has Been Signed on 12/16/2022 11:30 AM - 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:
198400280
ADMINISTRATOR:KRISTIN TURNERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 661-4654
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee - Kristin WilliamsTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 12/16/22. LPA arrived at the facility at 9:00 AM and was met by licensee Kristin Williams who guided analyst on a tour of the facility. LPA observed 3 infants, 7 toddlers and one assistant during the visit. The purpose of this visit is to observe the changes indicated on the updated facility sketch. Per facility sketch, bedroom 2 located downstairs and the patio area will now be used for children in care.

LPA observed bedroom 2 to have a storage cubby, child sized table, child sized chairs, a wall mounted television, storage cabinets, a desk and lap top. The storage cabinet was observed to have art supplies and sleeping mats. The outdoor patio area was observed to have child sized table, child sized chairs, patio furniture and a covered barbeque grill.

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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Kristin Williams

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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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