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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419243
Report Date: 03/18/2022
Date Signed: 04/05/2022 08:41:39 AM


Document Has Been Signed on 04/05/2022 08:41 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:PHILLIPS, ANGILICEFACILITY NUMBER:
013419243
ADMINISTRATOR:PHILLIPS, ANGILICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 536-8267
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:14CENSUS: 8DATE:
03/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Angilice PhillipsTIME COMPLETED:
04:25 PM
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On 03/18/2022 at 1:30pm, Licensing Program Analyst (LPA) Diana Campos arrived at the home for an unannounced 1 year required inspection. LPA met with the licensee, the licensee's fingerprint cleared spouse, and 9 children in care which consisted of one infant, 4 preschoolers and 4 school age children.

At 1:50pm, LPA toured the areas of the home used for the child care, with the licensee, to conduct a health and safety inspection. The home is a split level home, which is neat and clean with heating and ventilation for safety and comfort. The on limit areas include the living room, dining room, kitchen which will be used only to access bathroom, child care room and bedroom behind kitchen and bathroom on the lower level of the home. The off limit areas include the master bedroom and bathroom on the upper level of the home, bedroom to the right of hallway on lower level, the garage and small shed in the yard. These areas are made inaccessible by gate, closed and/or locked doors and visual supervision. The isolation area will be the living room, away from other children in care. LPA observed an ample supply of toys and activities accessible to children in care, and they are age appropriate and in good condition. There is a gate at the bottom of the stairs leading to the upper level of the home. The outdoor play area is the fenced backyard, which is free from defects or dangerous conditions. There is a working smoke detector, carbon monoxide detector, telephone, first aid supplies and a fully charged 3A40BC fire extinguisher. Per the licensee, there are no firearms in the home. The wall heater is screened, and the fireplace in the living room is blocked, to prevent access by children. LPA did not observe any bodies of water, hazardous items, or toxins accessible to children today. The licensee conducted fire and earthquake drills in 01/2022.
At 2:30pm LPA reviewed 5 children's files. The licensee's CPR/first aid certificates are current and expire on 11/20/2023. The facility roster was reviewed and a copy obtained. The licensee has a certificate of completion for the required mandated reporter training, but is due to renew.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
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.

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PHILLIPS, ANGILICE
FACILITY NUMBER: 013419243
VISIT DATE: 03/18/2022
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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

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 inspectionprocess@dss.ca.gov. 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/process

Licensee 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.

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 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.

There are no deficiencies being cited today.


A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Angilice Phillips

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
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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