192000828-7-5-2022-30-CC-JLAO-CG333L-20220705175340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192000828
Report Date: 07/05/2022
Date Signed: 07/05/2022 05:53:57 PM

Document Has Been Signed on 07/05/2022 05:53 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	JACKSON FAMILY CHILD CARE		FACILITY NUMBER:	192000828
ADMINISTRATOR:	JACKSON, MARJORIE & WILLIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 750-2587
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY:	14	CENSUS: 4	DATE:	07/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:36 AM
MET WITH:	Marjorie Jackson		TIME COMPLETED:	01:30 PM

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On 7/5/2022 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Marjorie Jackson.

Days and hours of operation are 6:00 a.m. to 6:00 p.m., Monday through Friday. Currently applicant cares for children ages birth to 10 years old.

LPA toured the home inside and outside and a census was taken; 4 children were present during the beginning of the inspection. with licensee and assistant. Licensee confirmed that the living room is the main activity room. Applicant confirmed children nap and eat in the space. The bathroom that children use is located outside the kitchen.

The following areas are currently OFF LIMITS: the kitchen, living room area outside the kitchen, bedroom 1 and bedroom 2 dining room and detached garage. Kitchen area is used as a walkway to access the back yard and children are always supervised. LPA informed licensee that any area designated as OFF LIMITS to the children in care, need to have doors closed/locked during the hours of operations.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible; stored in the closet outside the kitchen area.

The fireplace located in the living room is made inaccessible by a screen and glass door and will not be in use during daycare hours. LPA observed two open face heaters located in the living room area where children spend the majority of their time and the living room area outside the kitchen.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 192000828
	VISIT DATE: 07/05/2022

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There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA did not observed any stairs in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (323) 750-2587.

Licensee is available to care for infants. LPA observed one infant present during the inspection. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan will be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

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. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were incomplete and a Technical Advisory was issued. Licensee will ensure all children 12 months and under have a completed Individual Infant Sleeping Plan (LIC 9222) Licensee’s Mandated Reporter Training was not available for review. Licensee agrees to complete online training and submit proof of completion by 7/19/2022. Licensee’s pediatric CPR/First Aid was not available for review. Licensee provided expired CPR/First Aid certification and confirmed that she has valid card and will email a copy to LPA by 7/12/2022.

A review of records was not available and licensee was given a Type B citation. Licensee agrees to ensure all documents for licensee and assistant are readily available for review.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 192000828
	VISIT DATE: 07/05/2022

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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.

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.

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 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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Marjorie Jackson.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/05/2022 05:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 192000828
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview the licensee did not comply with the section cited above in 1 out of 1, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/26/2022
	Plan of Correction
1 2 3 4	Licensee agrees to have a completed personnel file ready for LPA's review. LPA provided Licensee a copy of the LIC311D for reference.

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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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