198400280-1-17-2024-54-CC-RDEO-CZL2AV-20240117161411

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400280
Report Date: 01/17/2024
Date Signed: 01/17/2024 04:14:26 PM

Document Has Been Signed on 01/17/2024 04:14 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:	198400280
ADMINISTRATOR:	KRISTIN TURNER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 661-4654
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	01/17/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Assistant - Elsie Johnson		TIME COMPLETED:	04:30 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) R. Derraco conducted an unannounced 3-year annual inspection to the above facility on 01/17/24. LPA arrived at the facility at 01:15PM and met with Assistant, S1, who guided analyst on a tour of the facility. Also present during this inspection were two additional assistants. Per S1, there are 14 children that are currently enrolled. There were 11 children present upon arrival, 4 of which are infants. LPA observed licensee, Kristin Williams arriving to the facility at 2:50 PM This is a two story duplex that consists of 4 bedrooms, 2 bathrooms, living room, dining/kitchen, laundry room, garage, and backyard (fenced). The off limits areas include 2 bedrooms, the kitchen/dining area, the upstairs bathroom, laundry room, and the garage. The main care area is located in the living room. LPA observed age appropriate toys, wall mounted television, a rocking chair, and a wooden cubby space for personal belongings. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the main care area. A wall heater with a cover mounted into the wall was also observed in the main care area. LPA observed a baby tension gate at the entrance of the kitchen. LPA did not observe any sharp or pointy objects accessible in the off-limits kitchen. Per licensee, food is provided for children in care. A second tension gate was observed at the entrance of the stairs leading to the off-limits second floor. Bedroom 3 was observed with 3 cribs, additional age appropriate toys, a baby changing table, a rocking chair for adults, and educational posters. Bedroom 4 was observed with children's reading material, board games, a child sized table with child sized chairs. Per Licensee, either bedroom can be used as an isolation area for children showing signs of illness. The outside activity space was observed with a bench, patio table and patio chairs. The backyard play area was observed with perimeter fencing, outdoor play equipment, a half-dome climbing structure and a wooden play house. Per licensee, outdoor play area is wiped down and sanitized after use. LPA observed the side of (page 1 of 3)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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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Document Has Been Signed on 01/17/2024 04:14 PM - It Cannot Be Edited

Created By: Randy Derraco On 01/17/2024 at 03:56 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: 198400280
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not have one cirb or play yard for each infant which poses a potential Health, safety and/or personal rights risk to persons in care.
	POC Due Date: 01/31/2024
	Plan of Correction
1 2 3 4	LPA will conduct a POC visit to clear citation

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.

SUPERVISOR'S NAME:

Denise Gibbs

LICENSING EVALUATOR NAME:

Randy Derraco

LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLIAMS FAMILY CHILD CARE	FACILITY NUMBER: 198400280
	VISIT DATE: 01/17/2024

NARRATIVE

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the duplex to have additional outdoor play equipment stored under a blue tarp. A gate with a lock was observed making the storage area inaccessible to children in care. 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. A pet dog was observed kept in the off-limits 2nd floor of the home. 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, 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 Child Care Center. 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. Licensee states that there are no firearms stored in the home. The licensee understands that storage areas for poisons must be locked, not just inaccessible. The restroom that children use was observed to be sanitary with an operable sink, faucet and toilet. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 02/21/23, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

Safe sleep guidelines were discussed with licensee. During the inspection, LPA observed 3 infants in care sleeping outside of a crib / playpen. LPA advised licensee that a citation under California Code of Regulation (CCR) section 102425(a) will be issued. 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.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 11/2025. LPA observed that the
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: 198400280
	VISIT DATE: 01/17/2024

NARRATIVE

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Licensee and assistants do have 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.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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 Kristin Williams

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC809 (FAS) - (06/04)

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