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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495045
Report Date: 03/18/2022
Date Signed: 03/21/2022 10:24:57 AM

Document Has Been Signed on 03/21/2022 10:24 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WILLIAMS CASAS FAMILY CHILD CAREFACILITY NUMBER:
197495045
ADMINISTRATOR:BECKY WILLIAMS CASASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 392-2008
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
03/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Becky Williams CasasTIME COMPLETED:
12:30 PM
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On 3/18/2022 Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with applicant, Becky Williams Casas for the purpose of a pre-licensing inspection of 331 W. Manchester Blvd., Los Angeles, CA 90301. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The applicant is applying for a Large Family Childcare License with a max capacity of 14. A fire clearance was approved by LA County Fire Department on 3/1/2022. Property deed is currently on file. Applicant resides in the home with 3 adults and 5 minor children.

Per the application, currently, the ages the applicant wishes to provide services for children newborn to 12 years old with the hours of operation of 6:00 a.m. to 6:00 p.m. Monday through Friday. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

The home is a multi unit home with 3 bedrooms, 2 bathrooms, 2 kitchens, 2 living rooms, a nursery room and office/storage room. The home does have an detached 3 car garage that will be OFF LIMITS to the children in care. Home has a front yard and back yard. The driveway is shared with the business next door. Facility is located on a main street.

Parents will access the home through the main entrance that gives access to a lobby like areas where facility has two entry ways. LPA observed a staircase that lead to the upstairs units- 333 ½ 331 1/2 W. Manchester Blvd. Inglewood CA. Currently upstairs units are vacant and do not have any tenants.

Entering the home through the main entrance, home has two entry ways, 2 doors, that give access to the home. LPA observed the entry way where parents will arrive in and children

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS CASAS FAMILY CHILD CARE
FACILITY NUMBER: 197495045
VISIT DATE: 03/18/2022
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will complete a wellness check. The parent board was observed to be in the entry way of the home next to the Fire Alarm Pull station. All necessary posting were observed by LPA.

Entering living room 2, which has been designated as the children’s area, LPA observed children’s size tables and chairs, children’s cubbies and variety of age appropriate toys. A wooden play kitchen and dramatic play area toys were observed in the space. A television set was observed mounted on the wall. Next to living room 2, the nursery was observed. Three cribs and a changing table was observed. LPA observed three high chairs in the space. All electrical outlets were covered. LPA observed applicant test the carbon monoxide and smoke detector located in living room 2/children's are and the nursery.

Kitchen 2 was observed to have safety gates at both entry ways, making the area in accessible to the children in care. Kitchen cabinets were observed to have safety latches. The stove, refrigerator, sink and counter space area were observed and inspected. Knives and sharp object were observed to be made inaccessible to the children in care. Applicant confirmed that facility will be providing meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. As a COVID precautions, LPAs advised applicants to use disposable paper goods. LPA observed a working fire extinguishers in the kitchen. LPA observed the water heater next to the refrigerator, locked and barricaded, making it accessible to the children in care.

LPA observed a hallway outside living room 2, designated as the chidlren’s area, where a closet was observed with a plastic door knob cover. Closet was observed to have children’s napping cots and extra cleaning supplies. Applicant was reminded that closet needs to remain locked at all times.

Office/storage room was observed next to the kitchen, area has been designated as off limits to the children in care. LPA observed a plastic door knob cover making it in accessible to the children in care. Outside the office/storage room, LPA observed a wall heater. LPA discussed different options with applicant to make the heater inaccessible to the children in care. At the end of the hallway, LPA observed bathroom 2 which will be used by children in care.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS CASAS FAMILY CHILD CARE
FACILITY NUMBER: 197495045
VISIT DATE: 03/18/2022
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A toilet, sink, cabinets and bathtub were inspected. All electric outlets were covered and cabinet under the sink and cabinet over the toilet were secured with a safety latch. LPA discussed COVID-19 recommendation such as using paper towels and displaying a handwashing sign for children to view. LPA will email additional signage.

Next to bathroom 2, LPA observed bedroom 3, designated as the sick room/ computer room. LPA observed children’s size tables and chairs. All electric outlets were covered, and LPA observed a carbon monoxide and smoke detector in the area.

Next to living room 2, LPA observed a Dutch door, double hung/half door, making living room 1, Kitchen 1, bathroom 1, bedroom 1 and bedroom 2 inaccessible. These areas are all OFF LIMITS to the children in care. LPA observed Kitchen 1 to have a door that leads to the side drive of the home. Bedroom 1 was observed to have a door that leads to the back yard of the home. LPA confirmed with applicant that the half door/dutch door needs to be closed at all times making the areas inaccessible to the children in care.

Facility will access the outdoor space through the side door next to the kitchen. Applicant confirmed children will be supervised at all times walking to the back yard located at the end of the property. LPA observed a gated area with age appropriate outdoor toys such as plastic slides, children size scooter and cars. The area is covered with artificial turf. LPA observed a shaded area for children to rest. LPA discussed with applicant the importance of supervision while playing outdoors.

LPA observed the detached garage that has been designated as OFF LIMITS to the children in care and will remain locked during the hours of operations. LPA observed the door with a plastic door knob covered, making it inaccessible to the children in care.

The following areas are off limits to the children in care: Living Room 1, Kitchen 1, Bedroom 1, Bedroom 2 and Bathroom 1 with detached car garage.

The following correction will be submitted by March 16, 2022.
1. Barricade/gate for wall heater in the hallway.

The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution. Exit interview was conducted with applicant Becky Williams Casas.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS CASAS FAMILY CHILD CARE
FACILITY NUMBER: 197495045
VISIT DATE: 03/18/2022
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The following was discussed with the applicant:
Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.


Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Keep in Your Family Child Care.

FORMS TO BE POSTED


LIC203 Facility License
LIC 610A Emergency Disaster Plan
LIC 9148 Earthquake Preparedness Checklist
PUB394 Notification of Parents Rights Poster
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS CASAS FAMILY CHILD CARE
FACILITY NUMBER: 197495045
VISIT DATE: 03/18/2022
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Children’s Records Requirements:
LIC 700 Identification and Emergency Information
LIC 627 Consent for Emergency Medical Treatment
LIC 282 Affidavit Regarding Liability Insurance
LIC 9150 Parent Notification Additional Children in Care
LIC 9166 Consent/Verification for Nebulizer Care
CDPH 286 (Immunization Blue Card) with Immunization record
PUB 72- Family Child Care Consumer Guide
LIC 995A Notification of Parent’s Rights
LIC 995E Caregiver Background Check Process
LIC 9212 Family Child Care Consumer Awareness Information
PM 286 California School Immunization Record (blue card)-http://www.dhs.ca.gov/publications/forms/immunization.htm
LIC 9224 Acknowledgement of Receipt of Licensing Report, if applicable.
Facility Records:
LIC 624B Unusual Incident/Injury Report
LIC 9040 Child Care Facility Roster
LIC 9052 Employee Rights,
LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
LIC 9149 Landlord Consent Form, if you plan to care for more 12 for Large
LIC 9151 Property Owner/Landlord Notification Form
Personnel Records as required in Tittle 22, Division 12, Chapter 3, Section 102416.1, including but not limited to proof of current pediatric CPR and First Aid Certificates, Preventative Health certificate and criminal record information.
Copy of your deed or lease/rental agreement
Documentation of Fire and Disaster drill
Proof of immunization's against pertussis (TDAP), measles (MMR), and influenza
Mandated Reporter certificate – www.mandated reporterca.com – renewed every two years.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS CASAS FAMILY CHILD CARE
FACILITY NUMBER: 197495045
VISIT DATE: 03/18/2022
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Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.



Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

LPA discussed the safe sleep regulations with applicant 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 applicant 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 plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WILLIAMS CASAS FAMILY CHILD CARE
FACILITY NUMBER: 197495045
VISIT DATE: 03/18/2022
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· Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license. · A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

· Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)

· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.

· Changes should be reported the to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from home.

· Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.

· Fire and safety drills must be performed every six months and documented for review by the Department.

· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

· LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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