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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422514
Report Date: 01/26/2023
Date Signed: 02/21/2023 02:18:22 PM

Document Has Been Signed on 02/21/2023 02:18 PM - 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:HUGHES, ANGELIQUEFACILITY NUMBER:
013422514
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Angelique HughesTIME COMPLETED:
12:46 PM
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An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 9:30 a.m. The licensee was present with two preschool-age children. Phone number and e-mail address are current. Hours: 6:00 a.m. - 5:00 p.m.
At 9:45 a.m., the day care area of the home was inspected. Areas licensed for child care: downstairs bathroom and den. Licensee also uses the multi-purpose room, which is the garage area in the back of the home. Licensee was reminded that the multi-purpose room is an extension of the day care and can only be used for activities, such as a movie or arts and crafts. There can be no sleeping or eating in this room. This was discussed in detail with the licensee. The majority of the day care must be in the licensed area of the home.
The licensee then requested that the kitchen nook be added as a licensed area of the home. Licensee was instructed to provide a new facility sketch. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision.
The home was clean and orderly, with adequate heating and ventilation. There were a variety of books and toys for children's use.
Facility has functioning cell phone and carbon monoxide detector (tested). Licensee stated there were no firearms or bodies of water on the premises. Fireplace is upstairs in an off limit area of the home. Back yard area is securely fenced.
Licensee currently has no infants in care, but LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and- resources/safe-sleep as an additional resource. Safe Sleep Handouts were given to the licensee. 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. (continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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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: HUGHES, ANGELIQUE
FACILITY NUMBER: 013422514
VISIT DATE: 01/26/2023
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LPA reviewed personnel, facility, and children's records at 10:59 a.m. Licensees' CPR/First Aid expires May, 2023. Last disaster drill completed January, 2023. Required postings are visible for public review. Facility roster was current. Children's files are complete. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall obtain a California clearance or criminal record exemption prior to working, residing or volunteering in a licensed facility. All adults present during this inspection were fingerprint cleared/associated to the facility.
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 maximum per day/per person will be assessed if this regulation is violated. Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary.
Also discussed with the licensee: supervision of children at all times; children are not to be left in parked vehicles; car seats and high chairs; Unusual Incident Reporting; advertisements; construction work at facility; paying fees on-line; smoking; ill children in home.
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/inspection-process.

Important E-mail Addresses:
Community Care Licensing General Information and Updates:www.ccld.ca.gov.
Mandated Reporter Training:www.mandatedreporterca.com (Child Care Providers Module - required every 2 years).
Alameda County Public Health Department Website: www.acphd.org
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/ cdss-programs/community-care-licensing/caregiver-background-check/guardian

SEE 809-D for deficiencies.
(continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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: HUGHES, ANGELIQUE
FACILITY NUMBER: 013422514
VISIT DATE: 01/26/2023
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NO DEFICIENCIES CITED.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Angelique Hughes.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
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