197415728-5-27-2021-30-CC-KMIL-C3ENRC-20210527104115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415728
Report Date: 05/24/2021
Date Signed: 05/27/2021 10:41:30 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 BROOKS FAMILY CHILD CARE		FACILITY NUMBER:	197415728
ADMINISTRATOR:	JACKSON BROOKS, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	3237785323
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY:	12	CENSUS:	DATE:	05/24/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:			TIME COMPLETED:	08:39 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 5/12/2021 at 2:30 pm, Licensing Program Analyst (LPA) Kristina Mitchell conducted a tele-visit to the Jackson Brooks Family Child Care Home for the purpose of conducting a Case Management inspection for a capacity increase. Due to Covid-19 the tele-inspection was conducted via FaceTime with licensee Jacqueline Brooks. The licensee has specified that she will operate for 24 hours, Monday - Friday, serving children 0 to 12 years of age. The licensee was advised that during hours of childcare that the licensee shall be present in the home and shall ensure children in care are always visually supervised. Residents in the home currently the licensee and her husband. All areas identified on the facility sketch were inspected. The areas that were inspected were the living room, dining room, family room, 2 bedrooms, 2 bathrooms, kitchen, laundry area and the exterior of the facility. Licensee stated that main care will be conducted in the family room, living room, dining room and the designated exterior of the home that will be used for outdoor play. When entering the home, an enclosed front patio area is utilized as a multi-purpose area for arrival. A COVID-19 sanitation check-in station, parent information board with LIC documents were observed in this area. Licensee also keeps emergency disaster preparedness kits, and storage bins with various holiday supplies in this area. After entering the home at the front door, you enter the living room that is not in use. This area is not off limits at this time but will be used for additional children when necessary. This area contains 1 couch, 1 chair and a fireplace that has a gate nailed to the wall and made inaccessible. The couch is also in front blocking the fireplace. Licensee has stated that the fireplace is inoperable. Connected to the living room to the right is room #1 which is for children to nap. 2 playpens and 7 cots were observed for the use of children in care. One (1) closet was observed containing the families clothing and additional materials for the day-care. Page 1 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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 8

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 BROOKS FAMILY CHILD CARE	FACILITY NUMBER: 197415728
	VISIT DATE: 05/24/2021

NARRATIVE

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There is a door which leads to the hallway of the home which is off limits to the children with a child proof handle.

Exiting room #1 through the living room leads to the dining room which contains a dining room table with 5 chairs and a small desk with 1 chair. This area is not off limits and is currently used for employees to clock in/out. This area will be used for additional children in care when needed. The living room and dining room have an open floor plan. There was a door observed to be kept closed that leads to the hallway containing the living areas of the home which are room #2 and restroom #1. This area is off limits to the children in care and has a child proof lock making it inaccessible to children in care. A dresser in this hallway is blocking the exit door leading into the napping room listed as room #1.

When exiting the dining room, you will enter the kitchen which is off limits to children and made inaccessible with a child proof gate. Lunches, snacks and water will be provided by licensee for children in care at this time due to COVID-19. All cabinets and drawers were observed to have child proof latches and locked with child proof locks making all items stored inaccessible. An additional area in the kitchen which is labeled on the facility sketch as the breakfast room is blocked with a baby gate making it inaccessible to children in care. This area is a multi-purpose area that is used for storage space for additional food items and an office space for licensee.

Attached to the entrance of the kitchen there is a hallway that is utilized for storage. The area was observed to contain additional toys, chairs and learning materials. Through the hallway there is an attached laundry room with a washer and dryer. There is built in shelving above the washer and dryer which contains cleaning materials placing them out of reach for children in care.

When exiting this hallway, you will enter the family room which is the main designated area for children in care. LPA observed cubbies with toys and manipulative, 1 storage unit with school learning supplies, 1 bookshelf, 2 highchairs, 1 small shelf containing additional learning materials, 1 large table with 7 chairs and 1 mounted TV with console containing DVD’s and TV equipment. The children’s restroom is located inside this room and all drawers and cabinets are locked and made inaccessible with child proof locks.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

Page: 2 of 8

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 BROOKS FAMILY CHILD CARE	FACILITY NUMBER: 197415728
	VISIT DATE: 05/24/2021

NARRATIVE

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The kitchen, laundry and bathroom cabinets and drawers are latched to make sharp objects, medications, toxins, poisonous items and detergents inaccessible to children in care. LPA observed adequate materials and equipment that are age appropriate for children.

Exiting the family room to the left behind a sliding door leads to the backyard which is the designated play area for children. LPA observed a small storage shed which contains paper towels, trash bags, and various additional non-toxic household supplies. 1 small play kitchen, multiple bikes, 1 small table with chairs,2 small fisher price play structures and 1 toy storage chest where also observed. An additional patio area in the backyard is made off limits with a gate which is about 4 feet tall with built in locks mounted into the wall making it inaccessible. Licensee has stated this area is used for the family only and is kept off limits. The backyard also contains a garage with a key locked door used for storage and is kept locked. The driveway leading to the front of the house contains 2 covered cars that are inoperable under a built-in canopy. Licensee states that this area is monitored by staff while children are outdoors playing. The gate leading to the front of the house is locked with a key preventing children from exiting.

A RAST assessment due to COVID-19 was conducted and additional materials were reviewed and emailed to applicant for posting. LPA observed postings throughout the home.

Licensee stated that there are no firearms kept on the premises. The fire extinguisher that is a 3: A:40-BC is up to date and was serviced in January 2021. Licensee has smoke detectors located throughout the home. The carbon monoxide detector is in the laundry room. Cleaning products are kept underneath the kitchen sink and laundry room above washing machine. Items are made inaccessible with child proof locks and out of reach of the children on a top shelf in the laundry room. Licensee’s First Aid/CPR Training expires 11/2021.

Licensee has submitted a Emergency Disaster plan. The licensee has completed Preventive Health and Safety/Childhood Nutrition and Mandated Report training. Notification of Parents’ Rights Poster and Emergency Disaster Plan are posted.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

Page: 3 of 8

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 BROOKS FAMILY CHILD CARE	FACILITY NUMBER: 197415728
	VISIT DATE: 05/24/2021

NARRATIVE

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The following was discussed with the applicant:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.

-The fire extinguisher type 3A-40BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)

-Fire and safety drills must be performed once every six months for a Small FCCH and once every month for a Large FCCH and documented for review by the Department.

-Smoking is prohibited in a family childcare home.

-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

-Dog(s) and or pets are recommended to be isolated from children in care.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

Page: 4 of 8

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 BROOKS FAMILY CHILD CARE	FACILITY NUMBER: 197415728
	VISIT DATE: 05/24/2021

NARRATIVE

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- No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

- Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

The facility is currently providing IMS. Incidental Medical Services (IMS) policy was discussed with the applicant. 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, are available at: http://www.ada.gov/childqanda.html.

Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be in children's files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the singed statement in the facility file.

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which Baby is always sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

Page: 5 of 8

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 BROOKS FAMILY CHILD CARE	FACILITY NUMBER: 197415728
	VISIT DATE: 05/24/2021

NARRATIVE

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In addition, LPA distributed LIC-311D and explained the following forms:

LIC311D:

CHILDREN RECORDS:

LIC: 700 Identification and Emergency Information, 702 Child’s Pre-admission Health History LIC 995E Caregiver Background Check Process, 995A Notification of Parent’s Rights, 627 Consent for Emergency Medical Treatment, 613A Personal Rights, LIC282 Affidavit Regarding Liability Insurance, LIC9150 Parent Notification, Additional Children in Care and Individual Infant Sleeping Plan LIC9227.

FACILITY RECORDS:

LIC9149 Property Owner/Landlord Consent, PUB 394 Notification of Parents Rights, PUB 269 California Child Passenger Safety Law, LIC 9040 Facility Roster, LIC624A Death Report, LIC6101A Emergency Disaster Plan, LIC9148 Earthquake Preparedness Checklist, LIC 624 Unusual Incident/Injury Report. LIC311D Forms/Records to keep In Your Family Child Care Home, Family Child Care Self-Assessment Guide.

STAFF RECORDS:

LIC 508 Criminal Record Statement, LIC 501 Personnel Record, LIC 503 Health Screening/TB, LIC9052 Employee Rights, LIC9108 Statement Acknowledging Requirement to Report Child Abuse, LIC 9163 Request for LIVE SCAN, LIC9188 Criminal Record Exemption Transfer Request, LIC 9182 Criminal Background Clearance Transfer Request, LIC9052 Employee Rights.

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541

Email Address: childcareadvocatesprogram@dss.ca.gov

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

Page: 6 of 8

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 BROOKS FAMILY CHILD CARE	FACILITY NUMBER: 197415728
	VISIT DATE: 05/24/2021

NARRATIVE

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The following were also discussed with the licensee:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division

300 N. Continental Blvd., Suite 290-A

El Segundo, CA 90245

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into childcare or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

Page: 7 of 8

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 BROOKS FAMILY CHILD CARE	FACILITY NUMBER: 197415728
	VISIT DATE: 05/24/2021

NARRATIVE

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Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each childcare center or family childcare home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program or an accredited college or university.

An exit interview was conducted via Tele-Visit with Applicant, Jacqueline Brooks. A copy of this report was issued to the applicant. A copy of this report is being emailed to the applicant and it has been explained that a reply to the email shall be considered a substitute for the hard-copy signature.

The applicant will be granted a large family childcare license for a capacity of fourteen (14) effective pending review by Licensing Program Manager.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Kristina Mitchell	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

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