013423357-7-11-2024-52-CC-EWOS-D73RWA-20240711132250

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423357
Report Date: 07/11/2024
Date Signed: 07/11/2024 01:23:45 PM

Document Has Been Signed on 07/11/2024 01:23 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	AGUDELO, ANGELA & CATACOLY, JOHN		FACILITY NUMBER:	013423357
ADMINISTRATOR/ DIRECTOR:	AGUDELO, ANGELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 688-2228
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	07/11/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Angela Agudelo		TIME VISIT/ INSPECTION COMPLETED:	01:30 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 July 11, 2024, at 11:30 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Angela Agudelo & John Catacoly for an Unannounced Annual/Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was the licensee's three fingerprint cleared assistants. Also present during the inspection were 10 preschool age children, and one (1) infant child. The licensee stated that the facility operates from Monday to Friday 7:00 AM to 5:00 PM. LPA toured the facility inside and out to conduct a Health and Safety inspection. This single-story home consists of three bedrooms, two baths, a living and dining room, kitchen, covered patio, in-law unit, and backyard. This home was clean and orderly, with (centralized) heating and ventilation for the safety and comfort of children. The Isolation area of the home will be a section of the living room, away from other children in care. The off-limits will be made inaccessible by closed and/or locked doors and visual supervision. LPA checked the cabinets in the kitchen, bathroom, on-limits bedrooms, and any other cabinets or drawers accessible to children in care and did not observe any hazardous materials or toxins accessible to children during today’s inspection. At 11:15 AM, LPA inspected the backyard area to make sure that there are no pools, hot tubs or any other bodies of water present that violates the childcare licensing laws and there were none, during today's inspection. The backyard area has a separate in-law unit that's off-limits to children in care. On-limit-areas are the: Living and dining room, kitchen, bathroom in hallway, covered patio, backyard, both bedrooms left side of home and bathroom Off-limit-areas are the: In law unit in backyard, bedroom that was converted from garage, laundry room next to covered patio, and shed. At 11:55 AM, LPA tested the smoke detector in bedroom (2) and the carbon monoxide detector in bedroom (2) and found them to be functioning properly. The licensee showed me her first aid kit that she keeps in the off limits bedroom next to the covered patio, and a fully charged 2A10BC fire extinguisher which meets standards established by the State Fire Marshal hanging on the wall next to the front door. See 809-C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AGUDELO, ANGELA & CATACOLY, JOHN	FACILITY NUMBER: 013423357
	VISIT DATE: 07/11/2024

NARRATIVE

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This home has a fireplace that has a barricade/screen to prevent access by children in the living room. LPA asked the licensee does she transports children and the licensee stated that she does not transport children. Per licensee there are no firearms in the home. All required forms are posted and visible for public review.

The OUTDOOR PLAY area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. During today's inspection, there are no play structures which are required to be anchored. There are ample age-appropriate toys that appear to be safe and in good condition and trees and a canopy for shade.

At 12:15 PM, LPA requested and reviewed the files of three (3) children in care and three staff files. All children’s files were complete and the staff files has the required Employee Rights and TB results. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 06/28/2024. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires on 03/2026. The licensee has completed mandated reporter training on 07/27/2023. The licensee is in ratio today.

Effective August 1, 2003, California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

See 809-C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AGUDELO, ANGELA & CATACOLY, JOHN	FACILITY NUMBER: 013423357
	VISIT DATE: 07/11/2024

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Angela Agudelo & John Catacoly, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See 809-D for deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee's Angela Agudelo & John Catacoly.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/11/2024 01:23 PM - It Cannot Be Edited

Created By: Elimika Woods On 07/11/2024 at 01:17 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AGUDELO, ANGELA & CATACOLY, JOHN	FACILITY NUMBER: 013423357
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which three assistants did not have their immunization records in their file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/12/2024
	Plan of Correction
1 2 3 4	Licensee will send LPA a copy of the assistants immunization records by 08/12/2024 by regular mail, fax, or email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Chandra Charles

LICENSING EVALUATOR NAME:

Elimika Woods

LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC809 (FAS) - (06/04)

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