197406067-6-23-2022-30-CC-JLAO-CFNTTD-20220623150034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197406067
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:00:44 PM

Document Has Been Signed on 06/23/2022 03:00 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:	197406067
ADMINISTRATOR:	JACKSON, CAROLYN J.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 299-0546
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY:	14	CENSUS: 3	DATE:	06/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:59 AM
MET WITH:	Carolyn J. Jackson .		TIME COMPLETED:	03:00 PM

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On 6/23/2022 Licensing Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Carolyn Jackson.

Days and hours of operation are 6:00 a.m. to 6:00 p.m., Monday through Friday. Facility provides care and supervision to children ages 2 years old to 12 years old.

LPA toured the home inside and outside and a census was taken; 3 children and 1 adult with licensee were observed providing care and supervision.

Current facility sketch reviewed, and Licensee confirmed that the back family room is use for the day care. Families access the day care room through the side entrance. LPA observed a half door/dutch door making the kitchen and the rest of the home OFF LIMITS. The bathroom that children use is located across from the family room. Licensee confirmed that children nap and eat in the family room.

The following areas are currently OFF LIMITS: main entrance of the home, dinning room, living room, bedroom 1, bedroom 2, bedroom 3 and bathroom 1 in the first floor and the second floor which includes bedroom 4 and bedroom 5 with bathroom 2. LPA observed safety gates in the bottom of the stairs located in the family room. A detached garage was observed to have a locked screen door and is OFF LIMITS to the children in care. LPA discussed with licensee that all areas designated as OFF LIMITS need to remain 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 and stored in the pantry closet in the kitchen. Licensee confirmed that the majority of detergents and cleaning compounds are kept in the locked garage.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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: 197406067
	VISIT DATE: 06/23/2022

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There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are fenced or barricaded when children under age 5 years old are present. LPA observed a children’s safety gate at the bottom of the staircase. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is 323-299-0546.

Fire place was observed to be barricaded with a metal gate. Living room area is OFF LIMITS to the children in care. Families access the day care through the side door of the home.

There are currently no infants in care and Licensee confirmed that facility does not enrolled children under the age of 12 months.

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 observed the back yard/outdoor area that is enclosed with a gate. LPA observed a cemented area with age appropriate toys and a canopy to provide shade to the children in care.

LPA reviewed a sample of children’s files and observed files were incomplete and a Technical Violation was issued. Licensee’s Mandated Reporter Training was not available for review. Licensee agrees to complete online training and submit proof of completion by 7/7/2022. Licensee’s pediatric CPR/First Aid expires on 6/2024. LPA recommended for licensee to enroll in a current Preventative Health and Safety Course to ensure licensee has the most updated information. LPA will email training opportunity to licensee.

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.

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/inspection-process.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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: 197406067
	VISIT DATE: 06/23/2022

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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.

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

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

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