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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192010570
Report Date: 10/04/2019
Date Signed: 10/14/2019 08:27:15 AM

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 CAREFACILITY NUMBER:
192010570
ADMINISTRATOR:JACKSON, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 329-1953
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY:14CENSUS: 7DATE:
10/04/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jacqueline JacksonTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), V. Wheatley conducted an annual inspection and met with the licensee at 10:30am. The parents enter through the rear. The licensee is a provider with the Gardena Child Care Program. LPA observed licensee and assistant on the premises with 7 children. The children were playing a game. The adults are fingerprint cleared. LPA toured the child care areas which are the rear day care room and one bedroom. LPA observed a child proof gate at the entrance of the hall to the bathroom. There are two bedrooms which are off limits and will remain inaccessible. The home is orderly, comfortable and well ventilated.

LPA observed a working carbon monoxide, smoke detector, charged 2A10BC fire extinguisher and working telephone. The home has a screed wall heater. There are several age appropriate toys and a first aid kit on the premises. All detergents, cleaning supplies, medications and sharp objects are inaccessible. LPA observed electrical outlets covered and inaccessible. LPA observed cribs and cots for napping. Per the licensee, there are no firearms on the premises. LPA observed CPR/first aid which expires August 2020.

Per the licensee, there are no children receiving Incidental Medical Services. Licensee understands if these children are enrolled a written plan must be submitted to the department.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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 2
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: 192010570
VISIT DATE: 10/04/2019
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LPA inspected the fenced backyard. LPA observed several age appropriate toys and equipment. The water tables will be emptied after each use. There is one dog on the premises which was observed in the licensee's bedroom (off-limits). There are no bodies of water on the premises. Licensee was reminded that children are to be supervised inside and outside of the home.

Licensee was reminded that all adults 18 and over living or working in the home and visiting on a frequent basis must be fingerprint cleared prior to being on the premises. A civil penalty will be assessed if this regulation is violated. LPA discussed discipline policies, personal rights, civil penalties and appeal rights.

LPA reviewed children's records and staff records at 11:30am which are complete. LPA observed immunizations and Mandated Reporter Training. Immunization records are to be obtained from parent's prior to a child being left with provider. Immunization records shall be kept on blue cards from the local health department. Licensee is receiving Child Care Quarterly updates. The additional information may be obtained at the department's website www.ccld.ca.gov The licensee conducts fire drills and earthquakes.

LPA observed the required forms posted. The children's roster is accessible. There are no violations according to Title 22 Regulations.

Exit interview.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC809 (FAS) - (06/04)
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