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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010214
Report Date: 08/16/2024
Date Signed: 08/16/2024 01:42:53 PM

Document Has Been Signed on 08/16/2024 01:42 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SMITH-WINSTON, ANGELEKA FCCHFACILITY NUMBER:
483010214
ADMINISTRATOR/
DIRECTOR:		SMITH-WINSTON, ANGELEKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 504-5177
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: DATE:
08/16/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Angeleka Smith-WinstonTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Glenn Ouye 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. Effective, July 18, 2024, the facility license was revoked and the revocation of the license is stayed for three years for providing over the counter medication to children without parent consent or knowledge.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
  • 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.
  • 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.

Continued on LIC809-C
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SMITH-WINSTON, ANGELEKA FCCH
FACILITY NUMBER: 483010214
VISIT DATE: 08/16/2024
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  • Licensee shall report to the Licensee 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 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).
  • The licensee shall, within 120 days (November 15, 2024) of the adoption of this Stipulation (July 18, 2024), complete 28 hours of training related to the allegations contained in the Accusation and approved by licensing. The training topics must include 1) 4 hours of proper administration of medication; and 2) 8 hours of management and supervision of employees; and 3) 8 hours of facility maintenance; and 4) 8 hours of proper supervision of children.

LPA discussed and reviewed the Stipulation and Waiver; and Order executed on July 18, 2024. A copy of the Stipulation and Waiver; and Order and the Accusation were given to the licensee. 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.

The licensee has completed all of the required training with the exception of the proper administration of medication training. Copies of the training certificates have been given to the Department. The licensee will be taking the Preventative Health and Safety training with the Solano Family and Children's Services on August 20, 2024 and August 21, 2024 and will provide the Department with a copy of the certificate upon completion.

Continued on LIC809C
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SMITH-WINSTON, ANGELEKA FCCH
FACILITY NUMBER: 483010214
VISIT DATE: 08/16/2024
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LPA Ouye conducted a tour of home. The licensee denied access to licensee's master bedroom. All other rooms and outdoor area's were inspected and meet the requirements of the Stipulation and Waiver; and Order.

All other components of the Stipulation and Waiver; and Order are being met.

Exit interview was conducted and the report was reviewed with the licensee. 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. There were no violation(s) of the California Code of Regulations, Title 22; Division 12 cited during today's visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC809 (FAS) - (06/04)
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