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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192010570
Report Date: 08/05/2021
Date Signed: 08/05/2021 03:41:44 PM

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) 819-8325
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY:14CENSUS: 9DATE:
08/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Jacqueline Jackson-LicenseeTIME COMPLETED:
03:47 PM
NARRATIVE
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On 8/5/2021 at 2:00 P.M., Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced Annual Random/ 1 Year Required visit for the Jackson Family Child Care Home. Present in the home were the licensee Jacqueline Jackson and 9 day care children. The home was inspected inside and out according to the facility sketch on file. The home was inspected for health and safety compliance per Title 22. Upon arrival LPA observed the assistant Vicky Bias at the end of her shift.
LPA observed the following:
Care and supervision were observed
The homes capacity was within the scope of the license
An appropriate size fire extinguisher was observed, last serviced 2/27/2021
carbon and smoke detectors were present.
Detergents,toxins, knives and other sharp items were inaccessible to children in care.
No guns or weapons present as stated by the Licensee, no weapons observed by LPA.
Properly working telephone
License, facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights Poster and California Safety Seat Law are posted

Pediatric CPR and First Aid Card expires 7/4/2022


No bodies of water on the premises
Children records available and in good order.
Staff files
Roster
Mandated Reporter certification expires 4/20/20
All open faced heaters and fireplaces were made inaccessible to children in care.
Toys, equipment and materials available and in good order
Children's outdoor activity area were observed, no hazardous conditions were observed during todays visit.
No bodies of water or spas were observed during todays visit. LPA observed a couple of empty wading pools, Licensee shall be reminded that when pools are not in use they are to be emptied immediately. Added supervision shall be practice when the pools are in use.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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: 08/05/2021
NARRATIVE
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The home has a properly working telephone
License, facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights Poster and California Safety Seat Law are posted
Pediatric CPR and First Aid Card expires 7/4/2022
No bodies of water on the premises
Children records available and in good order.
Roster was current and readily available for review
Mandated Reporter certification expires 4/20/2022
All open faced heaters and fireplaces were made inaccessible to children in care.
Toys, equipment and materials available and in good order.
The restroom available for children's use was clean and free of toxins and detergents.
Children's outdoor activity area were observed, no hazardous conditions were observed during todays visit.
No bodies of water or spas were observed during todays visit. LPA observed a couple of empty wading pools, Licensee shall be reminded that when pools are not in use they are to be emptied immediately. Added supervision shall be practice when the pools are in use.

The inspection was concluded, an exit interview was conducted and a copy of this report was provided to the licensee.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
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