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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700179
Report Date: 09/09/2025
Date Signed: 09/09/2025 12:14:07 PM

Document Has Been Signed on 09/09/2025 12:14 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
367700179
ADMINISTRATOR/
DIRECTOR:		JACKIE WILLIAMSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 531-6006
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
09/09/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Licensee Jackie WilliamsTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On September 9, 2025, Licensing Program Analyst (LPA) Zirbes, conducted an unannounced Annual/Random inspection. LPA met with Licensee, Jackie Williams to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. Per licensee, currently residing in the home is the licensee, and five children. All adults have eligible clearances. Current operating hours are Monday to Saturday. On Mondays the child care opens at 5:30am and closes on Saturday at 12:00am.
When LPA arrived to the home, there were a total of six children present with the Licensee providing supervision. All children were over the age of two. During LPA inspection, one additional preschool child arrived along with staff 1 (S1). Based on LPA observation, the family child care was meeting the capacity and ratio requirements.
Physical Plant: This is a single-story home, with three bedrooms, two bathrooms, kitchen, Day Care Playroom, Day Care Play Area, Day Care Learning Area, detached garage, front and back yard. Per Licensee, child care is provided in Day Care Playroom, Day Care Leaning Area, Day Care Play Area, hallway bathroom and the backyard. Off limit areas include all bedrooms, primary bathroom, kitchen, laundry room, and the detached garage. The off limits areas were inaccessible via child safety gates and child safety door knob covers. The home was inspected inside and out 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. According to Licensee and LPA observation, all cleaning products and medications are stored in two locked hallways closets, in the primary bedroom, and off limit laundry room and kitchen. Knives and sharp kitchen items were stored in the off limit kitchen. The kitchen is inaccessible to the children in care via a child safety gate. Report continued on page two
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700179
VISIT DATE: 09/09/2025
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Report continued from page one
Physical Plant continued: Safe and age appropriate toys, play equipment and materials were present. During the inspection the smoke detector and carbon monoxide detector were tested. An audible sound was heard when the items were tested therefore the smoke detector and carbon monoxide detector were found to be operable at this time. The home also has a fireplace which was inaccessible to the children in care via a fireplace screen and a bookcase. LPA did not observe baby bouncers/saucer chairs, or any recalled and or prohibited toys on the premises.
Bathroom (located in the hallway of the home): Toilet, sink, shower/tub were clean and operable. Zero cleaning products were stored in the bathroom.

Per Licensee, there are zero firearms/weapons stored in the family child care. In addition, per Licensee there are zero bodies of water on the property.

Outdoor: The backyard is utilized for outdoor play and is completely fenced. The backyard was equipped with a trampoline, a swing set, bikes, balls and a locked storage shed. The trampoline and swings were placed on grass. At the time of this inspection, the trampoline was off limits. During the tour of the outdoor activity space, LPA observed a glass aquarium (12 inches x 24 inches) filled with approximately three inches of water on the ground near the perimeter fence and accessible to the children in care. LPA observed one turtle in the glass aquarium. Licensee expressed the turtle has been on the property for a year, and the children are always supervised when outdoors. During this inspection, LPA observed a staff member was present in the outdoor activity with the children, when the children were engaged in outdoor play. LPA and Licensee discussed water safety. LPA advised the Licensee to obtain a cover for the aquarium which will make the water inaccessible to the children in care. While touring the outdoor activity space LPA observed a bike with a flat front tire, one scooter missing a wheel and another toy was missing the seat cover. LPA did not observe the children playing with these outdoor items. Per Licensee, the children have not been playing with these items due to the broken parts. LPA advised the Licensee to remove toys with broken or missing parts from areas accessible to the children. The items were removed and placed in the off limit garage.

Per Licensee, currently the only animal on the property is the turtle.

Report continued on page three
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700179
VISIT DATE: 09/09/2025
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Report continued from page two
LPA reviewed six child files, the Licensees file, and one staff files. Per LPA review six of six child files contained evidence of immunization's. However, the Licensee was not completing or updating the PM 286 as required. A technical violation was issued. One of two staff files reviewed did not complete the two year mandated reporter training as required. The Licensees mandated reporter training expired in April 2025. A technical violation was issued. During this inspection, the Licensee started the mandated reporter training. LPA and Licensee discussed the training requirement.

Review of records to be maintained: Per recorded documentation the last fire drill occurred in August 2025. The fire extinguisher was purchased in August 2025.
The following was discussed with the licensee:

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed facility representative 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.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/. Report continued on page four
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC809 (FAS) - (06/04)
Page: 4 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 367700179
VISIT DATE: 09/09/2025
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Report continued from page three

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Jackie Williams confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on LPAs observations and record review, four technical violations were issued.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Jackie Williams.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC809 (FAS) - (06/04)
Page: 9 of 9