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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626459
Report Date: 03/08/2023
Date Signed: 03/08/2023 02:10:21 PM

Document Has Been Signed on 03/08/2023 02:10 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, 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: 14CENSUS: 7DATE:
03/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Angela Smith TIME COMPLETED:
02:15 PM
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On 03/08/2023 at 1:15pm, Licensing Program Analyst (LPA) David Miller conducted an unannounced case management inspection for the purpose of a capacity increase from a small to a large license. LPA met with the licensee, who was on site with one staff and seven children (with one child being an infant, another seven years of age, and five toddlers.

On 08/12/2022, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved for fourteen (14) children on 08/23/2023.

This facility is a 2 story, 4 bedroom, 2 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for childcare are: Dining Room, Living Room, Kitchen, Family Room, Bathroom. Outside play area is completely fenced. The entire second story is off limits and is made inaccessible by a safety gate. The garage is also off limits and made inaccessible via a safety knob. No body of water was observed during time inspection. Hours of operation are: Monday through Sunday from 5:00 am-9:00 pm.

The fire extinguisher is rated 2A 10B: C. and is in the kitchen mounted on the kitchen wall. The smoke/carbon monoxide detector meets requirements and is operational. LPA observed that the home has sufficient space, toys, and equipment available for children’s use.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 376626459
VISIT DATE: 03/08/2023
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Licensee’s First Aid and CPR certifications expired on 03/02/2023. Licensee has required immunizations. Licensee completed the mandated reporter training on 09/15/2022. The facility roster is maintained and was reviewed. The last fire drill was conducted and documented on 03/01/2023. Licensee stated there are no bodies of water on the premises, and no weapons or ammunition in the facility. LPA observed no bodies of water during the inspection.

The Licensee was provided with the Ratio/Capacity Worksheet for a large family childcare home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home. Licensee stated that she does have property owner landlord consent (LIC-9149) to care for 14 children.

The Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate (SCCCA) information was provided. The Licensee is already enrolled in this program’s email
email list through the CCLD website, thus receives updated regulation information. Advocate information was provided: (916) 654-1541 and [email protected]

A large license may be issued after licensee submits an up-to-date CPR/First Aid card, and an office meeting. No deficiencies cited during today’s inspection on this date.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee Angela Smith
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
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