Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623331
Report Date: 08/01/2017
Date Signed 08/01/2017 11:27:40 AM

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: 9DATE:
08/01/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Shavonne WilliamsTIME COMPLETED:
11:35 AM
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
(1) LPA Angel Richards arrived at the facility 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 2 pet dogs, turtles, snakes, bearded dragon, a guinea pig and fish in the home. The hours of operation are: 6am-6pm Monday-Friday. Present were the Licensee, licensee's adult daughter Lexius Waltar, helper Kearrah Abram, 8 day care children, and the licensee's minor child.

The areas used for child care include the bathroom, daycare area, living room, kitchen and dining room. The off limit areas include 4 bedrooms via child proof door knobs and the garage via a lock. The home has a fenced backyard available for outdoor activities. There are 2 locked sheds which are off limits, a covered BBQ grill and the right side of the home is off limits via a gate. The fire extinguisher and smoke detectors/carbon monoxide detectors meet requirements and are operational. The last disaster drill was conducted on 4/3/17. 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, licensee's husband, licensee's son and licensee's daughter First Aid and CPR certifications expire in 4/2018. Helper Kearrah’s First Aid and CPR certifications expire in 9/2018. Licensee maintains a current facility roster. There is a working phone at the facility. Licensee maintains emergency records for children in care.

LPA discussed AB1207 Mandated Reported Training effective 1/2018. Additional information regarding CCL, resources and regulations can be obtained at the CCL website: www.ccld.ca.gov.

Provider was reminded of the following: Report suspected child abuse and neglect, maintain records according to regulation, keep items that read “keep out of reach of children” physically inaccessible to children in care Continued...
SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Angel RichardsTELEPHONE: 619-767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 CARE
FACILITY NUMBER: 376623331
VISIT DATE: 08/01/2017
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
26
27
28
29
30
31
32
Continued...Page 2

ensure that all adults living or working in the home have criminal background clearances/association prior to living or working in the home. Also that corporal punishment, smoking, exersaucers, bouncy seats, rockers, walkers, and jumpers are not permitted in the day care.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

No deficiencies are cited. The NOTICE OF SITE VISIT (NOS) MUST BE POSTED FOR 30 DAYS. LPA observed the NOS posted.
SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Angel RichardsTELEPHONE: 619-767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2