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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626459
Report Date: 10/24/2022
Date Signed: 10/24/2022 10:29:16 AM

Document Has Been Signed on 10/24/2022 10:29 AM - 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SMITH, ANGELA FAMILY CHILD CAREFACILITY NUMBER:
376626459
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
10/24/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Angela Smith TIME COMPLETED:
11:00 AM
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On October 24, 2022 at 10:16 am, Licensing Program Analysts (LPAs), David Miller and Rajani Goudreau conducted an unannounced Plan of Correction (POC) inspection at the facility. The purpose of this inspection is to ensure citation issued during the case management inspection on October 18, 2022 has been corrected. Upon arrival, LPAs met with Licensee, Angela Smith and proceeded to tour the facility.

Deficiency cited on 10/18/2022 was corrected as follows: licensee submitted an updated roster on when children attend the daycare.

Licensee submitted a plan of correction on 10/19/2022

LPAs observed Licensee to be within capacity limitations set forth on the license. LPAs observed five preschool aged children during today’s inspection.

Deficiency cited on 10/18/2022 has been cleared.

LPA provided Licensee, Angela Smith with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. An exit interview was conducted with the licensee, Angela Smith.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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