483000103-8-9-2023-01-CC-MAUN-CUJUHJ-20230809153602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483000103
Report Date: 08/09/2023
Date Signed: 08/09/2023 03:36:12 PM

Document Has Been Signed on 08/09/2023 03:36 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	WILLIAMS, CARMEN FAMILY CHILD CARE HOME		FACILITY NUMBER:	483000103
ADMINISTRATOR:	WILLIAMS, CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 642-0912
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	08/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Carmen Williams		TIME COMPLETED:	03:50 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	A Required-1 Year inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin to determine compliance with Title 22 and the terms of the Stipulation or Decision and Order. Effective, 10/14/22, the facility license was revoked, and the revocation of the license is stayed for three years due to an incident involving a domestic abuse situation which resulted in violation of a child's personal rights on 10/12/21. LS was granted probationary license subject to the following limitations and conditions: · Respondent shall operate the facility in strict compliance with the regulations and statutes governing the operation of a family child care home. · During the period, of probation, the Department in its sole discretion may conduct an unannounced site visit for the purpose of determining whether there is full compliance with the regulations and statutes governing the operation of a family day care home. · Respondent shall ensure that all individuals working, residing, or volunteering in the facility shall obtain criminal record clearances or exemptions prior to their initial presence in the facility and shall maintain proof of such criminal record clearances or exemptions at the facility. · Respondent shall maintain current personnel records of each employee at the facility and ensure that all employees have a current certificate of CPR and First Aid training and mandatory reporter training certificates on file at the facility. · The Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WILLIAMS, CARMEN FAMILY CHILD CARE HOME	FACILITY NUMBER: 483000103
	VISIT DATE: 08/09/2023

NARRATIVE

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· Respondent is required to maintain an accurate, complete, and current client roster which must be made available to the Department upon request.
Respondent shall report to the Licensing office the following: any unusual incident including, but not limited to, client death or injury which requires medical treatment, any suspected physical or psychological abuse of any clients,

any physical plan changes and all unexplained absences, law enforcement presence at the facility child care home, presence of A1 at the family child care home. These incidents must be reported by the next working day, and a

written report of the incident must be submitted within seven days following the occurrence of the incident.
· For the duration of the probationary period, Respondent shall inform all current and prospective parents of children in the facility of the facility's probationary license by providing to the parents a copy of the Stipulation and Accusation. Parents shall sign an acknowledgement indicating they have received a copy of the Stipulation and Accusation. The parental acknowledgement shall be maintained in the corresponding child's file and shall be made available to the Department upon request.
· Respondent shall maintain audible alarms that triggers an alert if anyone exits through either the front door of the home or the side door at the sunroom. The sensors of the audible alarm shall be set to be triggered at the short height of children so that children cannot slip under the sensor.
· Respondent shall maintain the gate, external to the sunroom, with latch that can only be opened by an adult.
· Respondent shall maintain additional gate that prevents children from eloping via sunroom side door.
· Respondent represented to the Department that Respondent is seeking Legal Separation from A1.
· Respondent affirms she voluntarily entered into the legal separation of her own volition and not due to pressure or suggestion by the Department.
· Respondent agrees to exclude A1 from the facility and should Respondent permit A1 to be present at the facility, Respondent will be in violation of the Stipulation, and Department shall have the authority to rescind the probation and permanently revoke Respondent's license. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WILLIAMS, CARMEN FAMILY CHILD CARE HOME	FACILITY NUMBER: 483000103
	VISIT DATE: 08/09/2023

NARRATIVE

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· Should A1 come to the facility without consent of Respondent, Respondent must call law enforcement and request law enforcement remove A1 from the premise.
Respondent must maintain accurate and up to date individual infant sleep plans for all infants in care.

A review of staff records on 08/09/2023 indicates that all facility staff or other individuals who require caregiver background checks received a criminal record and child abuse index clearances or exemptions. There was no evidence to suggest that A1 was on the premise. 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.

During today’s inspection the home and grounds were toured. The Licensee (LS) and two staff (S1 & S2) were supervising ten children and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 5:00AM to 4:00AM, Mon–Sun. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the entire second floor, an office on the first floor, living room and garage, and were made inaccessible by child’s safety gate and door locking mechanisms. The on limits area consisted of the Family room/one bathroom, Sunroom and backyard. LS installed several devices which includes installation of either wrought iron or wooden safety gates at the facility entrance(s)/Exits, locking mechanisms installed on entrances/exits doors, video cameras in interior sunroom and exterior perimeter backyard, functional audible alarm devices installed in the wooden gates in the backyard, as well as video camera which monitors each entrances/exits. The cameras are equipped with audio capabilities and motion detection that is linked to and sends images, video clips and multi alerts/signals to two different panels screens, as well as alerts are sent to the LS' mobile, facility's main phone and staff phones. The home was clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. Licensee’s EMSA approved pediatric CPR/First Aid certification expire 09/10/2024. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. There is a functional smoke and carbon monoxide detectors; and a fully charged fire extinguisher rated at least 2A10BC. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WILLIAMS, CARMEN FAMILY CHILD CARE HOME	FACILITY NUMBER: 483000103
	VISIT DATE: 08/09/2023

NARRATIVE

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The Licensee reported she did not store any firearm(s) or other dangerous weapon(s) on site; and none were observed by LPA. Poison(s) are key locked in a hallway closet. LPA reviewed three staff (S1-S2 & LS) records at 12:14pm, which revealed that the records contained current AB 1207 Mandated Reporter Training certificates, and proof of staff required immunization record and Employee Rights (LIC9052).

LPA reviewed seven children’s (C1-C7) records at 12:43pm which contained Identification and Emergency Information (LIC 700) and Consent For Emergency Medical Treatment, Immunization Record (IR) and IR transcribed onto the blue CDPH 286. The facility conducted an emergency drill within the past six months and the last drill was documented on 07/15/23. The facility roster of the children in care was reviewed and appeared to be complete. There were no bodies of water observed.

LPA discussed the safe sleep regulations with licensee 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 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. On this date, 08/09/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

(Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WILLIAMS, CARMEN FAMILY CHILD CARE HOME	FACILITY NUMBER: 483000103
	VISIT DATE: 08/09/2023

NARRATIVE

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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: https://www.ada.gov/resources/child-care-centers/.

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

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.
The Licensee provided proof of control of property.

Based on LPA's observations, LS was in compliance with the terms and conditions of the Stipulation and Waiver. Exit interview conducted and report was reviewed with the Licensee, Carmen Williams. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. There were no violation(s) of the California Code of Regulations, Title 22; Division 12, observed.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC809 (FAS) - (06/04)

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