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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103907998
Report Date: 11/08/2022
Date Signed: 11/08/2022 02:52:14 PM


Document Has Been Signed on 11/08/2022 02:52 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:JACKSON, REGINA FAMILY CHILD CAREFACILITY NUMBER:
103907998
ADMINISTRATOR:JACKSON, REGINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 916-2336
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:14CENSUS: 5DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Regina JacksonTIME COMPLETED:
03:00 PM
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On 11/08/2022, Licensing Program Analyst (LPA) Ka Vang conducted an unannounced Annual Required Inspection and was met by Licensee, Regina Jackson. During the inspection, Licensee's Assistant Debra Jackson also present. Days and hours of operation are Monday through Friday, from 7:00 AM-6:00 PM.

The home has a working telephone service and LPA confirmed the phone number is 559-916-2336.

LPA toured the home inside and outside. Census was taken and there five day care children present. Current facility sketch (LIC 999A) was reviewed, and Licensee confirmed that the family room, bedroom 1, and hallway bathroom are used for providing care and accessible to day care children. The kitchen is off-limits by the used of child safety gate made inaccessible to daycare children. All other rooms are off-limits and made inaccessible by use of plastic doorknob cover. There is a fireplace located in the living room, but the living room is made inaccessible to the children by the use of child safety gate. There are no firearms in the home. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are inaccessible.

This is a two-story home; the second story of the home is inaccessible to children as there is a child safety gate at the base of the staircase. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Fire drills are conducted and documented with the date, time and how many children present, every six months.

Safe toys and play equipment were observed and are in good condition, free of sharp, loose, or pointed parts. There is no pet in the home. The outdoor play area in the backyard is accessible to the children and is fenced and there are no hazards to children present.

Licensee has one infant (Child #1) enrolled in the facility. There is one play yard for each infant in care, the play yard is kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. Licensee provided proof of physically checking on Child #1 every fifteen minutes.



(Continued on LIC809-C)
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: JACKSON, REGINA FAMILY CHILD CARE
FACILITY NUMBER: 103907998
VISIT DATE: 11/08/2022
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LPA advised licensee that she is required to document any sign of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing on a sleeping log. Infants can be visually observed through an open door if sleeping in a separate room.

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-and-resources/safe-sleep as an additional resources. 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 ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter training was completed on 10/08/2022. Licensee’s pediatric CPR/First Aid expires on 10/2023. Licensee’s Assistant (Staff #2)’s Mandated Reporting training was completed on 11/23/2021. A review of record indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed, and Licensee is not providing IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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/childqanda.htm.

(Continued on LIC809-C)


SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: JACKSON, REGINA FAMILY CHILD CARE
FACILITY NUMBER: 103907998
VISIT DATE: 11/08/2022
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.


Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency was cited during today's inspection.

An exit interview was conducted with Licensee Regina Jackson. A copy of this report and Appeal Rights were provided and discussed. A Notice of Site Visit (LIC 9213) form issued and will be posted for 30 days.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4