Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623331
Report Date: 11/10/2015
Date Signed 11/10/2015 12:12:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WILLIAMS, SHAVONNE FAMILY CHILD CAREFACILITY NUMBER:
376623331
ADMINISTRATOR:SHAVONNE WILLIAMSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 252-6056
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 5DATE:
11/10/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Shavonne WilliamsTIME COMPLETED:
12:20 PM
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(3) LPA Angel Richards arrived at the home to conduct an Annual/Random visit. The single story home was toured and inspected to ensure an environment safe for the care and supervision of children. There are 4 turtles, 2 dogs, and 2 snakes in the home. The hours of operation are: 6am-6pm Monday-Friday. Present were the Licensee, helper Fabiola and 5 day care children (1 is licensee's child). Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include family room, kitchen, daycare area and the bathroom. Off limits areas include 4 bedrooms and 1 bathroom by the use of child proof door knobs and the garage by the use of a lock. The home has a fenced backyard that is off limits. The fire extinguisher, carbon monoxide detector and smoke detector meet requirements and are operational. The last disaster drill was conducted on 9/9/15. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water or weapons in the home. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire on 4/29/16. Helper Fabiola's First Aid and CPR certifications expire on 8/1/17. Licensee maintains a current facility roster. LPA reviewed a sample of Children’s Records which contain the Notification of Parents’ Rights and Immunization Records as required.

Provider is reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, keep items that read “keep out of reach of children” inaccessible to children in care, post all required forms, ensure that all adults living or working in the home have criminal background clearances prior to living or working in the home. LPA reviewed SIDs, SUID’s, and Back to Sleep. Also that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not permitted in the day care.

No deficiencies are cited. NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Mary A RichardsTELEPHONE: 619-767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2015
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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