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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422514
Report Date: 07/17/2024
Date Signed: 07/17/2024 01:15:32 PM

Document Has Been Signed on 07/17/2024 01:15 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HUGHES, ANGELIQUEFACILITY NUMBER:
013422514
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
07/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Angelique HughesTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 07/17/2024 Licensing Program Analysts (LPAs) Kareeca Sykes and Ashley Curry conducted an unannounced Increase of Capacity Inspection. LPA's met with licensee, Angelique Hughes, who has applied for Large Family Childcare home license with a capacity of 14. An approved fire clearance was received 06/06/2024. Also present for the inspection were 3 children in care consisting of 1 preschooler and 2 school aged children. LPA's toured the facility with licensee for a health and safety inspection. The facility plans to have hours of operation Monday - Friday 6am-6pm.

The licensee completed 8-hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8-hour Pediatric CPR & First Aid Certificate that expires 06/2026, has documentation for Measles, Pertussis, and Influenza vaccine. The licensee has Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Licensee has completed and submitted certificate for Mandated Reporter training which expires 6/2026. LPA's reminded the licensee that when caring for more than 12 and up to 14 is provided, licensee must notify parents and provide parents form LIC 9150 - Parent Notification of Additional Children in Care. The licensee will use the Affidavit Regarding Liability Insurance form to inform parents they do not carry a day care insurance. The licensee has a working telephone in the home.

This is a 3 story home. The home consists of 2 bedrooms 2 bathrooms, living/dining area, kitchen, den, and backyard.

Indoor: LPA's toured the indoor space of the home. The home is sanitary and orderly, with central heating and ventilation for safety and comfort. There are stairs in the home that are made inaccessible to children. LPA's observed fully charged 2A10BC fire extinguisher, a working duel smoke and carbon monoxide detector. There are enough age-appropriate furnishings, toys, books, and learning materials available. Door access to off limit areas are made inaccessible to children. Licensee states there are no weapons in the home.

Areas on On-Limit:

Second Level: Living/dining area, Kitchen, Bathroom

Lower Level: Den, Bathroom, Backyard

Areas Off- Limit:

Upper level: Bedroom

Second Level: Bedroom

Isolation areas:

LIVING ROOM (Second Level)

Outdoor play area: LPA's toured the outdoor area. The patio is fenced on all sides. LPA's did not observe any bodies of water in the outdoor area

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HUGHES, ANGELIQUE
FACILITY NUMBER: 013422514
VISIT DATE: 07/17/2024
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Licensure is contingent upon manager approval, final file approval, and completion of the following below.
  • Please submit a picture of the cabinet below the kitchen sink, which shows it is locked and secured. The licensee was advised that all poison must be in a locked cabinet/drawer or placed out of reach of children.

The licensee provided proof of control of property.

Because the licensee rents/leases the home, proof of landlord notification is required. The LPA's observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Family Child Care Homes LPA's 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-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Angelique Hughes, confirmed that there are no Registered Sex Offenders living in the facility and LPA's completed the RSO profile in FAS.

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: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC809 (FAS) - (06/04)
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