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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
013422514
Report Date:
03/03/2023
Date Signed:
03/03/2023 12:42:29 PM
Document Has Been Signed on
03/03/2023 12:42 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, ANGELIQUE
FACILITY NUMBER:
013422514
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
1
DATE:
03/03/2023
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
11:30 AM
MET WITH:
Angelique Hughes
TIME COMPLETED:
12:52 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 11:34 a.m. The licensee was present with 1 day care child (preschool) . LPA continued to review facility files and facility records. Facility was found to be in compliance.
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:
03/03/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/03/2023
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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