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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300049
Report Date: 04/25/2024
Date Signed: 04/25/2024 02:58:42 PM

Document Has Been Signed on 04/25/2024 02:58 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
336300049
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Joan WilliamsTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
NARRATIVE
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On April 25, 2024 at 2:45 PM, Licensing Program Analyst (LPA), Cindy Hamilton, made an unannounced Case Management visit to deliver an amended LIC 809 for visit conducted on 04/11/24. LPA met with Licensee Joan Williams , who was informed of the reason for the premise visit. LPA made corrections to the LIC 809 dated 03/06/2024. The correct date of the original report dated March 6, 2024 should be 04/11/2024 and verbage regarding the spa.

An exit interview was conducted, and a copy of this report , appeal rights and Notice of Site Visit was provided to the Licensee..

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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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