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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364803632
Report Date: 09/30/2022
Date Signed: 12/19/2022 05:09:21 PM

Document Has Been Signed on 12/19/2022 05:09 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
364803632
ADMINISTRATOR:WILLIAMS, APRILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 797-7846
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
09/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee, April WilliamsTIME COMPLETED:
04:25 PM
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****AMENDED REPORT: Type A citation dismissed based upon appeal granted on 11/08/2022*****
On 09/30/2022, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct a required/annual inspection as part of a compliance review. Present during this inspection were Licensee, April Williams and Adult Resident, Fred Bramal. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

Normal days and hours of operation are: Monday through Friday, 6:00am to 6:00pm
OFF-LIMIT AREAS INCLUDE: BEDROOM #1, BEDROOM #2, BATHROOM #1, PANTRY, AND GARAGE/WELLNESS ROOM
The facility is operating within the licensed capacity and appropriate ratios
· Appropriate supervision provided during this inspection
· A working telephone is present and current number on file
· Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection.
· Fireplace is properly screened to prevent access by children
· All hazardous items are stored inaccessible to children
· Toxins are locked
· Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations
· Facility is a single-story residence
· Verification of control of property on file (Mortgage payment stub)
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
· Mandated Reporter Training expired on 09/06/2019
· Pediatric CPR and First Aid Card will be completed on 10/08/2022
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 364803632
VISIT DATE: 09/30/2022
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· There are no bodies of water present at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Clean and age appropriate toys
· Current roster on file
· Documentation of fire and disaster drills on file
· Children’s records are complete
· Employee’s records are complete
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed on 9/30/2022 indicate that all adults who require caregiver background checks have not received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee April Williams 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 April Williams 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.

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.html

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 364803632
VISIT DATE: 09/30/2022
NARRATIVE
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- Licensee April Williams 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.

- 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.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:


1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

See LIC809-D for cited deficiencies.

LPA Hogue informed licensee April Williams that this report dated September 30, 2022 document(s) (4) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Also, LPA Hogue informed the licensee April Williams to provide a copy of this licensing report dated September 30, 2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.



The LICENSEE, April Williams, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Exit interview conducted and report was reviewed with the licensee April Williams.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/19/2022 05:09 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/19/2022 04:09 PM


Created By: Aman Sharma On 09/30/2022 at 02:44 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 364803632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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****AMENDED REPORT: Type A citation dismissed based upon appeal granted on 11/08/2022*****
Based on observation and record review, the licensee did not comply with the section cited above in, Adult #1 has been fingerprinted; however, as of this inspection, fingerprints for Adult #1 are pending/"In Process" meaning Adult #1 has not received a criminal record clearance or criminal record exemption which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2022
Plan of Correction
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****AMENDED REPORT: Type A citation dismissed based upon appeal granted on 11/08/2022*****
Immediately, during this inspection, Licensee contacted the parent of Child #1 and had Child #1 picked up early from the facility, which left Licensee caring for her two grandchildren. Licensee agrees to provide care for her grandchildren only, until the fingerprint status for Adult #1 has been determined. Licensee understands and agrees to not enroll new children until the fingerprint status is determined. During this inspection, Licensee wrote a statement documenting her understanding of the above information.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2022 04:17 PM - It Cannot Be Edited


Created By: Destinee Hogue On 09/30/2022 at 02:44 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 364803632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in, Licensee has not renewed AB1207 Mandated Child Abuse Reporter certificate. AB1207 certificate was completed on 09/16/2022 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2022
Plan of Correction
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Licensee agrees to renew AB1207 Mandated Child Abuse Reporter certificate on or by 10/14/2022
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Kimberly Williams
LICENSING EVALUATOR NAME:Destinee Hogue
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022


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