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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818986
Report Date: 11/19/2021
Date Signed: 11/19/2021 08:30:41 AM

Document Has Been Signed on 11/19/2021 08:30 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
334818986
ADMINISTRATOR:WILLIAMS, CHARLOTTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 776-2813
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Charlotte WilliamsTIME COMPLETED:
08:30 AM
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On 11/19/2021 at 8AM, Licensing Program Analyst Giselle Carbullido arrived at the facility to conduct an annual inspection. LPA met with Charlotte Williams, Licensee. Ms. Williams informed LPA that she is not currently operating the day-care due to COVID since 2020 and thought she was on inactive status. LPA Carbullido informed Licensee of the process for inactive and Licensee completed and submitted the LIC9211 during this visit. LPA Carbullido reviewed conditions and fees while on inactive status. Licensee placed on inactive status from (11/19/21) through (11/19/22).
LPA reminded Ms. Williams that annual license fees must be paid promptly and before reopening the day-care.

Exit interview was conducted with Ms. Williams and a copy of this report was provided during this visit.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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