<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423691
Report Date: 03/19/2025
Date Signed: 03/19/2025 04:40:43 PM

Document Has Been Signed on 03/19/2025 04:40 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:ROJAS, ANGELINAFACILITY NUMBER:
013423691
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 3DATE:
03/19/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:27 PM
MET WITH:Angelina RojasTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/19/2025, Licensing Program Analysts (LPAs), A. Hollinger and K. Sykes conducted a Case Management - Licensee Initiated Inspection. Licensee has applied for a capacity increase from a small FCCH (max CAP 8) to a Large FCCH (max CAP 14). Present during today's inspection were Licensee and Licensee's husband as well as 3 children in care consisting of 2 preschoolers and 1 school-ager. Facility is in ratio today. The home was toured with the Licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00 AM to 5:00 PM.

Community Care Licensing (CCL) has received an approved fire clearance on 02/25/2025.
Per Inspector Antonio Jimenez from Oakland Fire Department, the home is approved for a large with the garahe and storage area off-limits; daycare is approved for children ages two - five.

This is a single-story family home which consists of 4 bedrooms, 2 bathrooms, living room, dining room, laundry room, kitchen, storage room, garage, and backyard.

The On-limit areas: The living room, two (2) bedrooms, and one (1) bathroom, the kitchen, dining room, and backyard.

The Off-limit areas: The remaining two bedrooms (2), one (1) bathroom, laundry room, storage room, garage, and side yard. The Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and 100% visual supervision at all times.

The isolation area is located on the couch in the living area.


See 809-C for continuance------------------------------------------------------------------------------
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Ashley Hollinger
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ROJAS, ANGELINA
FACILITY NUMBER: 013423691
VISIT DATE: 03/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2

There are age appropriate toys in the home. There are no firearms in the home as stated by the Licensee. LPAs did not observe any hazardous materials or toxins accessible to children today. A sample of children's files were reviewed. LPAs observed a sign-in/sign-out sheet during file review.

Home is neat and clean, with ventilation for safety and comfort. Children sleep on cots in the living room. The home has a fully charged 2A10BC fire extinguisher. The home is equipped with several working dual smoke and carbon monoxide detector throughout the home. There is a working telephone in the home. The applicant’s CPR and First Aid certificate is current and expires 10/21/2025. Licensee completed mandated reporter training and it expires 12/10/2025. Licensee is in compliance with immunization requirements. The fireplace is blocked and screened. The backyard is fenced. Pets consist of 1 medium sized bull terrier locked away in the back of the yard. Licensee is the owner of the property and verification was viewed.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02CCP. 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) or (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.

No deficiencies observed at this visit.

The licensee must complete and provide proof of the following to LPA Hollinger for Licensee to be approved for a capacity increase to operate as a large family day care home with a maximum capacity of 14 when a fully qualified assistant is present:

- Backyard construction to be completed

A Notice of Site Visit was provided and must remain posted for 30 days.

Exit interview conducted and report reviewed with Licensee, Angelina Rojas.

SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Ashley Hollinger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2