073406563-11-30-2023-02-CC-MMAR-CY3QZF-20231130113641

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406563
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:36:47 AM

Document Has Been Signed on 11/30/2023 11:36 AM - 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, 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: 4	DATE:	11/30/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Glorious Jackson		TIME COMPLETED:	12:00 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 11/30/23 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy conducted an Unannounced Required Inspection at Glorious and Derek Jackson's Family Child Care Home. LPAs met with Licensee, Glorious Jackson and explained the purpose of today’s inspection. Present in the home were Licensee Glorious, and four(4) day care children (preschool age).Co-licensee Derek Jackson was not present at start of inspection. Glorious stated he had left to run errands. Facility is in compliance with required ratios today. Days/hours of operation are Monday-Friday from 6 am to 6pm. Adults present in the home have Criminal Background Check Clearances. INDOOR space was inspected. It is a single floor home. Access to day care is through the side yard gate. LPA observed sufficient materials, toys, and play equipment. Children were engaged in various activities under the supervision of the Licensee. All detergents, cleaning compounds, medications, and other similar items were inaccessible to children. Furniture and equipment were age appropriate and in good condition. There were no baby walkers, jumpers or bouncers observed during inspection. The home is sanitary, orderly and safe. LPA observed a fully charged fire extinguisher that meets State Fire Marshal standards and working smoke/carbon monoxide detectors. There is no fire place or stairs in the house. There are no pets in the home. LPA reviewed a current Children Roster, Emergency Disaster Plan LIC610A. Last fire/disaster drill was completed 08/23/23. All required postings were observed posted on a wall. Licensee states she sometimes transports children and has appropriate car seats. She provides snacks/meals and food storage area was observed to be sanitary. IN USE AREAS: Playroom (converted garage), bathroom in playroom, kitchen and family room.OFF LIMIT AREAS: Laundry closet in play room, dining area, all bedrooms, all other bathrooms.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JACKSON, GLORIOUS & DEREK	FACILITY NUMBER: 073406563
	VISIT DATE: 11/30/2023

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OUTDOOR space was inspected. Play equipment was observed in safe condition and free of hazards. Heavy structure was secured to the ground. The yard was fenced and there were no bodies of water observed.
IN USE AREAS: Children play area with play structure. OFF LIMIT AREAS: rest of the yard (outside gated area).
FILE REVIEW: Children, Licensee, Assistant files were reviewed. Licensee’s Mandated Reporter Training is current and CPR/First Aid is current (exp 11/2025 ).

The supervision of children was discussed, and Licensee understands that she must be present in the home during 80% of the operating hours and ensure children are supervised at all times.If no Assistant 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 was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California

On this date, 11/30/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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: 11/30/2023

NARRATIVE

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LPA discussed the Safe Sleep regulations with Licensee and 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

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

In the areas that were evaluated, no regulatory violations were observed.
Exit interview conducted and report was reviewed with the Licensee, Glorious Jackson. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. An Assistant arrived during inspection and Co-licensee, Derek Jackson returned after some time. A Notice of Site Visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

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