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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422674
Report Date: 06/15/2023
Date Signed: 06/15/2023 10:00:44 AM


Document Has Been Signed on 06/15/2023 10:00 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:MENA, ANGHELLAFACILITY NUMBER:
013422674
ADMINISTRATOR:MENA, ANGHELLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 245-9202
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:14CENSUS: 2DATE:
06/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Anghella MenaTIME COMPLETED:
11:18 AM
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Licensing Program Analyst Sidney Cortez, met with licensee Anghella Mena for an Unannounced Annual Random Inspection. Present for this visit was the licensee Anghella Mena. Present are 2 pre school age children, and her fingerprint cleared assistant Andrea Campos. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:00AM until 6PM, MONDAY-FRIDAY. The home is two story which consists of 3 bedrooms and 2 bathrooms, kitchen, living room, dining area, family room, and garage located on the 2nd floor; and day care room, infant room, and bathroom located on the lower floor. The home is neat and clean with centralized heating and ventilation for safety and comfort.


On Limit" Areas (accessible to children in care): Downstairs: Main room and side rooms: there are safe toys, play equipment and materials which appear age appropriate and adequate for the children in care. Stairs separating upstairs, gated. Restroom (one): available for children’s use. The toilet and sinks are in good repair. Backyard/Outdoor play area: Gated. Toys are in good repair and appear safe. There are no pools, hot tubs or other bodies of water. "Off Limit" Areas (not accessible to children in care): Upstairs area. Backyard area (outside of play area). The Off-limit areas are inaccessible by gate and visual supervision.The ISOLATION AREA will be the backroom part of the playroom area.


All hazardous materials and toxins are kept out of the reach of children. Per licensee, there are no firearms in the home. The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit.The home has a fully charged (3A10BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (October, 2023). The licensee's mandated reporter training is current and expires (June 2024). Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on May 10, 2023.
2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney CortezTELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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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