073406563-3-2-2020-02-CC-CCON-BMBRDC-20200302115544

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406563
Report Date: 03/02/2020
Date Signed: 03/02/2020 11:55:50 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, GLORIOUS & DEREK		FACILITY NUMBER:	073406563
ADMINISTRATOR:	JACKSON, GLORIOUS & DEREK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 237-2611
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94804
CAPACITY:	14	CENSUS: 8	DATE:	03/02/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Glorious Jackson		TIME COMPLETED:	12:12 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	Licensing Program Analyst Caroline Colson met with Glorious Jackson and her adult grandson, Derek Jackson for an unannounced random annual inspection at 10:12 AM. Licensee Derek Jackson arrived at 10:35 AM. There are 6 preschool children and 2 infants present. One child's record was reviewed by the LPA and the licensee on 3/2/2020 at 11:06 AM. C1 has a complete file. The home was toured to conduct a health and safety inspection. The home is one story home. The home consists of a living room, formal dinning room, kitchen with eating area, four bedrooms, 2 1/2 bathrooms, unfenced front yard, converted garaged which is a playroom and fenced back yard which is divided into three separate areas. The off limit areas are all the bedrooms, formal dinning room, 1 1/2 bathroom and unfenced front yard. Mrs. Jackson will use one section of her fenced back yard for outdoor play. The home has a 3A40BC fire extinguisher, a working combination smoke and carbon monoxide detector. There is central heating in the home. Mrs. Jackson states there are no firearms in the home. The living room is the isolation room. She conducts fire/disaster drills every six months. Her infant CPR and First Aid certificates are current and expire on September 21, 2021. She has a first aid kit. There are no pets. This facility is not providing Individual Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417. Please LIC 809 C for additional information

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020

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, GLORIOUS & DEREK	FACILITY NUMBER: 073406563
	VISIT DATE: 03/02/2020

NARRATIVE

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REMINDERS/RESOURCES

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

All adults will send their Measles, Pertussis and Flu or Flu waiver to our department within 30 days.

Licensee will send pictures of the formal dinning room being barricaded from the children in care.

There were no deficiencies cited during this inspection.

Notice of site visit was posted at the time of the inspection and must be posted for 30 days. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020

LIC809 (FAS) - (06/04)

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