073404261-10-23-2019-02-CC-MGUT-BH8P78-20191023110330

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073404261
Report Date: 10/23/2019
Date Signed: 10/23/2019 11:03:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	JACKSON, BILLIE		FACILITY NUMBER:	073404261
ADMINISTRATOR:	JACKSON, BILLIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 758-7660
CITY:	PINOLE	STATE: CA	ZIP CODE:	94564
CAPACITY:	14	CENSUS: 6	DATE:	10/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Billie Jackson		TIME COMPLETED:	11:20 AM

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 10/23/19, Licensing Program Analyst (LPA), Melissa Guirit met with licensee Billie Jackson for an UNANNOUNCED RANDOM INSPECTION. Present for this inspection were licensee, fingerprint cleared husband, Farrell Jackson, 1 infant, and 5 preschoolers. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are from 6:30 AM to 6:00 PM. The home is two story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, kitchen dining area, lower level bathroom, lower level bedroom (napping/changing area), and the converted garage (playroom). The OFF LIMIT AREAS are the kitchen area where the stove is located and the entire upstairs area which will be inaccessible with a barrier gate and visual supervision. The ISOLATION AREA remains in the nap/changing room. The outdoor play area is fenced and free from defects or dangerous conditions. There are ample age appropriate toys and materials that appear to be safe and in good condition.The backyard is still divided into sections - the pool area which is gated and lock to prevent access by children, the center portion of the backyard where the patio furniture and deck area is located, the left side of the backyard which also gated is where the day care children play. There is also a locked shed in this area where the licensee keeps tools. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. The home has a fully charged 3A40BC fire extinguishers, working smoke detectors, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The licensee and husband's CPR and First Aid certificate is current and expires 10/2020. Licensee and husband completed the Mandated Reporter Training which expires on 09/2021. Licensee is compliant with the new immunization law. There is a fireplace in the first floor bedroom but, it is blocked to prevent access by children. The licensee conducts and documents fire and disaster drills with last one being on 03/2019. LPA reminded licensee that a drill should be done this month. See 809-C for continuance.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JACKSON, BILLIE	FACILITY NUMBER: 073404261
	VISIT DATE: 10/23/2019

NARRATIVE

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(6) Children files were reviewed, and facility roster reviewed and copy obtained. Per licensee, there are no firearms in the home. All REQUIRED forms are posted and visible for public review.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.gov

Incidental Medical Services was discussed with the licensee. During today's inspection, LPA mentioned about the IMS Plan that was submitted into the Regional Office, however, licensee no longer cares for that specific child.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with licensee.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019

LIC809 (FAS) - (06/04)

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