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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500845
Report Date: 06/02/2023
Date Signed: 06/02/2023 12:03:07 PM

Document Has Been Signed on 06/02/2023 12:03 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WILLIAMS, ASTONDAFACILITY NUMBER:
344500845
ADMINISTRATOR:ASTONDA WILLIAMSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 235-5438
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Astonda WilliamsTIME COMPLETED:
12:30 PM
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On 06/02/2023, Licensing Program Analyst Katy Maestas (LPA) met with Applicant Astonda Williams (A1) for the purpose of a pre-licensing inspection. LPA disclosed the purpose of the inspection and was granted entrance into the Family Childcare Home (FCCH). LPA provided the Entrance Checklist to A1. Also present in the FCCH was A1's souse. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. A1’s tentative hours of care are Monday through Friday, from 6:00 AM until 7:00 PM. A1 does not intend on providing overnight or weekend care. A fire inspection was granted on 05/16/2023 for the residence.

A health and safety inspection was conducted inside and outside of the FCCH. A1 accompanied LPA for the entirety of the tour. The FCCH is a two-story house. The first floor contains a dining room, family room, kitchen, bathroom, bedroom, and access to the garage. The second floor contains 3 bedrooms, bathroom, master bedroom and bathroom. LPA verified that toxic and hazardous items were inaccessible to children in care. LPA observed stairs that were barricaded by a baby-gate making the stairs inaccessible to children in care. LPA observed a fire place in the family room which was barricaded by glass; however, A1 stated that she will not use the fireplace during operational hours. The outdoor play area was toured which includes the front yard. A1 understands that the front yard is not fenced and will require 100% supervision of children. A1 stated that she may use a local park, which is within walking distance, for outside play. LPA toured the backyard, enclosed patio, and side yards. LPA observed a shed in the backyard which contains an empty spa with a latching lid. A1 stated that she owns 2 dogs. The OFF-limits areas of the FCCH are the garage, the entire second floor, the enclosed patio, backyard, shed, and both side yards. A1 understands that OFF-limits areas must remain inaccessible to children in care.

A functioning smoke detector and carbon monoxide detector was observed and tested in the downstairs bedroom. LPA observed cleaners and medications to be stored on shelves that are high up and out of reach to children in care. LPA observed knives stored in kitchen drawers that have child safety locks on them. A 2A10BC fire extinguisher was observed in the kitchen and appeared to be in the green zone.


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SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WILLIAMS, ASTONDA
FACILITY NUMBER: 344500845
VISIT DATE: 06/02/2023
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LPA observed a firearm properly secured in a lock box and ammunition stored separately.

LPA discussed Mandated Reporter Training with A1. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their Mandated Reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com. The training is currently provided in English and Spanish. A1 has a current Mandated Reporter Training Certificate which will expire on 04/27/2025. Current Pediatric CPR and First Aid training was verified for A1 and expires on 03/09/2025. Completion of Preventative Health and Safety training, including nutrition and lead exposure, was verified before the inspection. Proof of required immunizations for A1 was also verified before the inspection.


LPA discussed the Safe Sleep Regulations with A1 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 A1 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. LPA discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months old. LPA provided a copy of the LIC 9227/Individual Sleeping Plan to be completed for infants under 12 months old.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: Incidental Medical Services (IMS) policy was discussed with A1. 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.

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SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WILLIAMS, ASTONDA
FACILITY NUMBER: 344500845
VISIT DATE: 06/02/2023
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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, 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.

A1 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.

A1 understands that licenses are not transferable, and once licensed, Licensee must live in the home and be present for 80% of the operating hours. A1 understands that if an unusual incident occurs; Licensing is to be notified via phone call, e-mail or fax within 24 hours and the LIC 624/ Unusual Incident Report shall be submitted within 7 days to remain in compliance. A1 understands that if any structural changes are made to the FCCH; Licensing must be notified PRIOR to construction.



A1 understands that if she wants to make any OFF-limits area an ON-limits area, she must notify Licensing and LPA must do an inspection BEFORE children are allowed in said area. A1 understands that children’s and staff’s records are to be maintained according to Title 22 regulations and be accessible to Licensing for up to 3 years. LPA reviewed with A1 the LIC 311D Forms/Records To Keep In Your Family Child Care Homes, Children’s Forms/Records, Facility Forms/Records, and Information to be Posted. A1 understands that fire drills must be conducted and documented once every six months.

As of today, 06/02/2023, A1 is approved for a Large Family Child Care Home licensed to serve 12 children (when there is an assistant present) with no more than 4 infants, or a capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without an assistant, the ratios revert to those for Small Family Child Care Home.

An exit interview was conducted and the report was reviewed with A1. LPA provided Licensee Appeal Rights to A1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC809 (FAS) - (06/04)
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