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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370815668
Report Date: 06/24/2022
Date Signed: 06/24/2022 02:20:05 PM

Document Has Been Signed on 06/24/2022 02:20 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WILLIAMS, THEODORA FAMILY CHILD CAREFACILITY NUMBER:
370815668
ADMINISTRATOR:THEODORA WILLIAMSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 670-1201
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 12TOTAL ENROLLED CHILDREN: 11CENSUS: 12DATE:
06/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:Licensee, Theodora Williams TIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Licensee, Theodora Williams and granted entry after identifying herself and disclosing the purpose of her visit. Present in the home today were 10 day care children, 2 grandchildren one of which is an infant. The licensee is using the following areas for daycare: Living room, dining room, family play room, bathroom, kitchen, outdoor patio, backyard. Off limit areas include: All upstairs, garage, front yard. Business Hours are: 6am to 5pm Monday through Friday. Licensee provided a copy of their current roster and is operating within the licensed ratio and capacity.

At 10:15am, LPA and licensee tested the carbon monoxide/smoke detector located in the playroom. Fire extinguisher was also fully charged. LPA did not observe any bodies of water on the premises. Licensee, Williams advised there are no firearms or ammunition stored on the premises.

Fireplaces and open face heaters are screened to prevent access by children. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. Outdoor play area is fenced and free of hazards. The last disaster/fire drill was conducted on 06/24/22. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WILLIAMS, THEODORA FAMILY CHILD CARE
FACILITY NUMBER: 370815668
VISIT DATE: 06/24/2022
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Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights. Pediatric CPR and First Aid cards are current and will expire on 06/2023. All staff have completed the mandated Child Abuse Reporting as per AB1207 through 2023. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain 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.

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 for 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.

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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WILLIAMS, THEODORA FAMILY CHILD CARE
FACILITY NUMBER: 370815668
VISIT DATE: 06/24/2022
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to: [email protected]. 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 today’s visit, no deficiencies were observed at this time. Exit interview conducted and report was reviewed with Licensee, Williams. 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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC809 (FAS) - (06/04)
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