<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400586
Report Date: 04/20/2023
Date Signed: 04/20/2023 12:29:14 PM

Document Has Been Signed on 04/20/2023 12:29 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:NORMAN FAMILY CHILD CAREFACILITY NUMBER:
198400586
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
04/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Kolisha Williams, Licensee sisterTIME COMPLETED:
12:48 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 Analysts (LPA) Susann Sanchez conducted an unannounced case management inspection for an increase in capacity at the above facility on 04/20/2023 at 11:10 AM. LPA was greeted at the door by Licensee assistant Ashley Simmons and also present was Licensee sister Kolisha Williams. At 11:15am Kolisha Williams guided LPA on a tour of the whole facility. There were 5 children, 1 school-age, and 2 adults present when LPA arrived. Per assistant and sister, Licensee Robin Williams will not be available to for the inspection due to a personal matter but was available by text message. Kolisha Williams also has a Family Child Care home license but is assisting her sister during this inspection.

Facility capacity is in compliance for a small Family Child Care Home. Per Licensee sister, hours of operation will be Monday through Sunday, 12:00 am to 11:59 pm and does not to exceed 24 hour care at one time. Licensee states that she will care for children Infants -13 years of age.

This is a two-story home which consists of 5 bedrooms (all upstairs), 4 bathrooms, classroom/den, kitchen, dining room, living room, garage, front and backyard. Areas used by children include: classroom/den, living room, bathroom located in the living room, and backyard. Areas off limits include: All of upstairs which include 5 bedrooms and 3 bathrooms, kitchen, dining room, garage, and front yard.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Knives and other sharp utensils are located in high cabinet in the kitchen. Cleaning products were located in the locked pantry closet.

The home is clean and orderly, there are outlet covers throughout the home. Smoke detectors and carbon monoxide detector were observed, tested and found to be operable.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586
VISIT DATE: 04/20/2023
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
Licensee has completed the required health and safety training, the Pediatric First Aid and CPR Expires on 02/04/2025 . Licensee has proof of immunization against pertussis and measles, influenza. Proof of Mandated Reporter Training was also submitted.

LPA reviewed assistant file and upon file review around 11:35am, LPA did not see her immunization's in her file. Type B was cited.

LPA observed age appropriate toys and learning materials. The required (2A10BC) fire extinguisher was observed in the den/classrom and was serviced on 06/22/2022. First Aid kit is available. Per Licensee, there are no weapons or firearms in the facility, none were observed by LPA. There is central air in the home.



Currently licensee does not have any infants enrolled. LPA observed 0 play yards/cribs. LPA reminded License sister the following: napping equipment should not block entrances or exits. Infant mattresses need to be firm with tightly fitted sheets. Loose object, bumpers, objects hanging, or objects attached to the cribs/play yards are not allowed.

Children are using the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care.



There is a fountain in the front yard. Licensee has removed the water and signed a declaration (in file) stating the fountain will always be empty and children are not allowed in the front yard alone. Front yard is only used for drop off and pick up.

LPA provided the Safe Sleep regulation and provided PIN 20-24-CCP and the Infant Sleep Plan LIC 9227 for when Applicant is ready to enroll infants. Children and infants will nap in the daycare room, mats are available.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586
VISIT DATE: 04/20/2023
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
The isolation area for a sick child waiting to be picked up will be in the classroom next to the exit away from other children.

The following was discussed with the Licensee sister:

· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization, Mandated Reporter training certificate www.mandatedreporterca.gov, and a valid criminal record clearance associated to the facility license. A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.


· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586
VISIT DATE: 04/20/2023
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
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: http://www.ada.gov/childqanda.htm

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA requested a copy of Licensee current CPR & 1st aid via email and a copy of an updated facility sketch to update file.

Corrections needed: Assistant Ashley Simmons immunization record.

Once corrections are received LPA will submit application to the Department for final review.



Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (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.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Kolisha Williams, Licensee sister, including, but not limited to Appeal Procedures and Appeal Rights.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 04/20/2023 12:29 PM - It Cannot Be Edited


Created By: Susann Sanchez On 04/20/2023 at 11:58 AM
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: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2023
Section Cited
HSC
1597.622(a)(1)

1
2
3
4
5
6
7
Employee and Volunteer Immunization Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. This requirement was not met as evidenced by: Based on interview and record
1
2
3
4
5
6
7
Per licensee, she will get the immunization's records and email proof to LPA by POC due date of 05/11/2023.
8
9
10
11
12
13
14
 review licensee did not provide proof of licensee did not provide proof of Immunization's against TB, Measles, pertussis and Influenza or declination for assistant. This poses a potential Health, Safety or Personal Rights risk to children in care
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5