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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010853
Report Date: 05/21/2026
Date Signed: 05/27/2026 02:54:15 PM

Document Has Been Signed on 05/27/2026 02:54 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SMITH-WINSTON, ANGELEKA FCCHFACILITY NUMBER:
483010853
ADMINISTRATOR/
DIRECTOR:		SMITH-WINSTON, ANGELEKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 504-5177
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 2DATE:
05/21/2026
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
03:14 PM
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Licensing Program Analyst (LPA), Dianne Allee, made an unannounced Case Management – Legal/Non-Compliance visit to the facility and met with Licensee, Angeleka Smith-Winston for the purpose of ensuring compliance with the terms of the Stipulation and Waiver; and Order. Licensee stated that she is getting ready to leave for a graduation, but invited LPA inside to conduct the visit. Licensee stated that she does not currently have employees due to operating at the capacity of a small FCCH. Effective, July 18, 2024, the facility license was revoked and the revocation of the license is stayed for three years for providing over the counter medication to children without parent consent or knowledge. Did not comply by providing adequate supervision resulting in child burning hands while washing hands while using bathroom sink. Did not comply with criminal record clearance requirements by permitting an uncleared adult to be present, reside at or care for children at the facility without criminal record clearance. The licensee was granted probationary license for three years subject to the following limitations and conditions:

· Licensee shall operate the facility in strict compliance with the regulations and statues governing the operation of a family child care home.

· During the period of probation, the Department, in its sole discretion, may conduct unannounced site visits for the purpose of determining whether there is full compliance with the regulations and statutes governing the operation of a family child care home.

· Licensee shall ensure that all individuals working, residing, or volunteering in the facility shall obtain criminal record clearance or exemptions prior to their initial presence in the facility and shall maintain proof of such criminal record clearances or exemptions at the facility.

Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Dianne Allee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2026
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SMITH-WINSTON, ANGELEKA FCCH
FACILITY NUMBER: 483010853
VISIT DATE: 05/21/2026
NARRATIVE
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PAGE 2

· Licensee shall maintain current personnel records of each employee at the facility and ensure that all employees have a current certificate of CPR and First Aid Training on file at the facility

· Licensee shall ensure that poisons, detergents, cleaning compounds, and other toxic products that could pose a danger to children are stored in a manner which is inaccessible to children.

· Licensee is required to maintain an accurate, complete, and current client roster which must be made available to the Department upon request.

· Licensee shall report to the Licensing office the following: Any unusual incident including, but not limited to, client death or injury which requires medical treatment, any suspected physical or psychological abuse of any client, any physical plant changes, and all unexplained absences. These incidents must be reported by the next working day via phone to the department, and a written report of the incident must be submitted within seven days following the occurrence of the incident.

· Licensee shall maintain current personnel records of each employee pursuant to California Code of Regulations, section 102416.1

· Licensee shall ensure that the facility is clean, safe, sanitary, and in good repair at all times.

· For the duration of the probationary period, licensee shall inform all current and prospective parents of children in the facility of the facility's probationary license by providing to the parents a copy of the Stipulation and the Accusation. Parents shall sign an acknowledgement indicating they have received a copy of the Stipulation and the Accusation. This parental acknowledgement shall be maintained in the corresponding child's file and shall be made available to the Department upon request.

· Licensee's TrustLine registration shall be revoked.

· Facility maximum capacity shall be reduced to ten (10) for the term of probation. After a period of two (2) years, if the licensee is in substantial compliance with this stipulation, the licensee may petition, in writing, the Regional Office to strike this term and return the licensee to full Large FCCH capacity of fourteen (14).

LPA discussed and reviewed the Stipulation and Waiver; and Order executed on July 18, 2024. A copy of the Stipulation and Waiver; and Order must be posted just inside the the main entry day care entrance(s) for parent viewing.

Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Dianne Allee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SMITH-WINSTON, ANGELEKA FCCH
FACILITY NUMBER: 483010853
VISIT DATE: 05/21/2026
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PAGE 3

The licensee has completed all of the required training which was agreed upon in the Stipulation and Waiver: and Order. Copies of the training certificates have been given to the Department by the licensee.

LPA Dianne Allee conducted a tour of home. Cleaning compounds were observed to be stored up high out of reach of children, on top of the refrigerator. Licensee stated there are no poisons stored in the home and none were observed. LPA oberved a key lock doorknob on garage where poisons could be stored if acquired. LPA received a current roster of children in care. LPA reviewed the records of five children currently enrolled to ensure each file contained a signed acknowledgement indicating they have received a copy of the Stipulation and the Accusation. Through observation and record review, it has been determined that the Licensee has met the requirements of the Stipulation and Waiver; and Order.

Licensee Mandated Reporter Training is valid to 1/2028, Pediatric First Aid & CPR is valid through 3/2027.

Exit interview was conducted and the report was reviewed with the licensee, Angeleka Smith-Winston.

Appleal rights were given. A notice of site visit was given and must remain posted for 30 days.

There were no violation(s) of the California Code of Regulations, Title 22; Division 12 cited during today's visit.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Dianne Allee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026
LIC809 (FAS) - (06/04)
Page: 4 of 4