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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334846574
Report Date: 08/06/2025
Date Signed: 08/06/2025 08:59:58 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/08/2025 and conducted by Evaluator Perla Ordonez
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20250508130222
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
334846574
ADMINISTRATOR:WILLIAMS, XERIAN & TATIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 335-6883
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:14CENSUS: 5DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Licensee Tatiana Williams and Licensee Xerian Williams TIME COMPLETED:
09:10 AM
ALLEGATION(S):
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Licensee does not live in the home
INVESTIGATION FINDINGS:
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On the date and time listed, Licensing Program Analysts (LPAs) Perla Ordonez and Taityana Benson arrived at the facility to deliver the findings of this complaint investigation which was initiated on 05/14/2025. LPAs met with Licensee Tatiana Williams. Licensee Xerian Williams was not present downstairs upon LPA arrival though came down at 08:32AM. LPAs toured the facility, took census, and discussed the following with the Licensee.

During the investigation, LPAs made observations, reviewed pertinent documentation and conducted interviews with pertinent parties.

It was alleged Licensee does not live in the home.

LPAs investigated the allegation and gathered the following information:
Please see LIC9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Perla Ordonez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 09-CC-20250508130222
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 334846574
VISIT DATE: 08/06/2025
NARRATIVE
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It was reported, on or about May of 2025, that Licensee did not live at the licensed facility on 36651 Cordoba Trail, Beaumont, CA 92223. LPAs reviewed pertinent documentation and noted that Licensee Tatiana Williams had a different address listed on their current Driver’s License that did not match the licensed facility address. Additionally, the department has on file signed declarations from Licensee Xerian Williams and Licensee Tatiana Williams, dated 05/15/2024, which state that each Licensee would be updating their Driver’s Licenses to reflect the 36651 Cordoba Trail address. As of today’s date, Licensee Tatiana Williams’ Driver’s License has not been updated. LPAs conducted interviews with pertinent parties who stated that Licensee Tatiana Williams does not live at the facility and instead has another place of residence. Licensee Tatiana Williams stated that they live at the currently licensed facility but also stated that they have a secondary place of residence they attend on a regular basis.

Based on information obtained during this investigation through interviews conducted and the review of pertinent documentation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC9099D.

See LIC9099-D for cited deficiency.

Additionally, LPAs also reminded Licensee Xerian Williams that, before receiving their license, all applicants are made aware of their responsibility to live in the home where care is provided.

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.

Exit interview conducted and report was reviewed with the Licensee Xerian Williams and Licensee Tatiana Williams.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Perla Ordonez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20250508130222
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 334846574
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2025
Section Cited
CCR
102417(a)
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(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times... Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement is not met as evidenced by:
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Tatiana Williams stated they wanted to remove themself from the license during today’s visit. A new LIC279 has been obtained reflecting the change as well as a statement from Tatiana Williams requesting to be removed from the license.
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Based on interview and record review, the licensee did not comply with the section cited above as the preponderance of evidence standard has been met regarding Licensee Tatiana Williams does not live in the home which poses a potential health, safety or personal rights risk to persons in care.
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Additionally, Licensee Xerian Williams agrees to write a written statement of understanding regarding regulation 102417(a). Licensee Xerian Williams agrees to write a declaration stating where their primary residence is located. Licensee agrees to send proof of Plan of Correction by 08/20/2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Perla Ordonez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
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