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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494467
Report Date: 02/14/2020
Date Signed: 02/14/2020 10:16:35 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:DILLARD-JACKKSON FAMILY CHILD CAREFACILITY NUMBER:
197494467
ADMINISTRATOR:DILLARD-JACKSON, ZENANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 236-5399
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 0DATE:
02/14/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Zenani Dillard-Jackson, ApplicantTIME COMPLETED:
10:30 AM
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On 02/14/2020 at 8:15am, Licensing Program Analyst (LPA), Adrian Risher conducted a pre-licensing inspection for a family child care home. The pending application is for a relocation of the daycare and an increase in capacity. LPA met with applicant Zenani Dillard-Jackson at 8:15am and toured the facility. The applicant is the only individual present at the time of the inspection. LPA did not observe any children present. The home is clean, orderly and comfortable. All adults in the home have been fingerprinted. Applicant's fingerprints will be transferred and associated to the new facility number. The hours of operation will be 24 hours Monday thru Friday. Applicant is requesting to have a family child care home with a capacity of 14. The fire clearance was granted on 02/03/2020 by Inspector Steve Porras.

This is a one story single family home. The home has 2 bedrooms and 1 bathroom. The daycare will consist of living room, dinning room and the bedroom on the left next to the rest room. These areas were inspected by LPA. The other bedrooms are considered off-limits and inaccessible. Applicant is renting the home. Applicant provided property owner/landlord consent form with the application. Applicant provided Landlord Notification with the application. The parents will enter the home from the front entrance. The living room will be considered the play room. Licensee stated that the children will have free play in the living room. The dining room will be considered the classroom. Licensee stated that the children will primarily be learning in the dining room. The older children will be eating in the dining room at age-appropriate tables and chairs. Licensee stated that she will be providing transportation for pick up and drop off for the school-age children. Licensee stated that she will be hiring an assistant. Licensee stated that she will submit the paper work for the assistant's fingerprints to be transferred and associated to the new license. LPA observed 4 cribs in the bedroom that will be used for napping. LPA observed cots stored in the hallway closet that will be used for napping for the older children. Licensee stated that the older children will be napping in the playroom(living room) on the cots. LPA observed 4 highchairs in breakfast nook off of the kitchen.

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
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 6
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: DILLARD-JACKKSON FAMILY CHILD CARE
FACILITY NUMBER: 197494467
VISIT DATE: 02/14/2020
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LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA observed safety latches on all of the cabinets and drawers in the kitchen and the bathroom. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children. The knives are stored in a drawer in the kitchen with a safety latch attached to it. The cleaning supplies are stored in an upper cabinet in the kitchen. The medications will be stored in the upper cabinet above the refrigerator. Licensee stated that she will be providing food for the children. She plans to sign up for the food program. The breakfast nook will be used as the isolation area for ill children.

LPA observed age appropriate toys, furniture and activities for children while in care at the facility. The outside play area is a grassy area with a concrete driveway. The outside play area is gated all around. Licensee stated that she does not currently have outside toys for the children at this time. There no bodies of water. LPA observed a dip in the grassy area that could pose a potential risk to the children in care. Licensee stated that she will have her gardener even it out. LPA observed an additional dip in the grassy area towards the back of the yard near the gate. LPA recommended that the Licensee place a gate in this area to prevent the children from having access to it. LPA took pictures of these areas. Applicant will provide LPA with pictures of the these 2 areas once they have been fixed.

LPA observed a charged fire extinguisher (2-A:10-B:C). LPA tested the smoke detector and carbon monoxide detector. LPA observed electrical outlets with protective covers over them. Applicant has a first aid kit which includes tweezers and band aids. Licensee stated that she will purchase a thermometer. The home does not have central air & heat. LPA observed 2 wall heaters with gates around them. The heaters are inaccessible to the children. Applicant stated that she will purchase fans and open the windows during the warmer weather.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: DILLARD-JACKKSON FAMILY CHILD CARE
FACILITY NUMBER: 197494467
VISIT DATE: 02/14/2020
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Applicant has current CPR, first aid, health and safety which expires 03/24/2020. Per the applicant, there are no firearms on the premises. Applicant reports that there are no pets in the home. The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible.

Copies of immunization records and mandated reporter training has been reviewed and completed. These items have been submitted to the department with the application.


The following corrections were discussed with applicant in order for the home to be ready for conducting child care:

1. thermometer- applicant will send a picture to LPA once it is purchased
2. dips in outside play area- applicant will send a picture of the outside play area once the safety concerns have been resolved.

A license to operate a Large Family child care home will be reviewed following final administrative review, and receipt of outstanding corrections needed. No license will be issued today 02/14/2020. Applicant will notify LPA when corrections have been made, and the Applicant has 30 days to complete corrections.

Exit interview and copy of report provided. Appeal rights have been reviewed and provided.

The following was thoroughly discussed with the licensee:

Applicant was made aware that once licensed, it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Applicant was also encouraged to read the Child Care quarterly updates to remain informed of any changes or updates to the Regulations.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: DILLARD-JACKKSON FAMILY CHILD CARE
FACILITY NUMBER: 197494467
VISIT DATE: 02/14/2020
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Applicant was made aware 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 child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as follows: Phone Number (916) 654-1541 and Email Address: childcareadvocatesprogram@dss.ca.gov

Applicant agrees to operate the family child care home in a way to reflect a home-like environment and agrees to the following per Children’s Personal Rights Title 22 Regulation(s): 102423 (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (1) To be treated with dignity in his/her personal relationship with staff and other persons. (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. (3) To have parents or guardians informed by the licensee of the provisions of the law regarding complaints and the procedures for registering complaints confidentially, including, but not limited to the address and telephone number of the licensing agency's complaint unit. (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

Applicant was reminded of their responsibility to report suspected child abuse. Mandated Reporter Training is required and needs to be renewed every 2 years.



Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Applicant was made aware that state law prohibits baby walkers, bouncers/bouncy seats, exersaucers, infant napping portables and any similar items within these categories.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: DILLARD-JACKKSON FAMILY CHILD CARE
FACILITY NUMBER: 197494467
VISIT DATE: 02/14/2020
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If cited for a Type A Deficiency, the Notice of Site Visit must be posted at the entrance of the facility along with a copy of the licensing report (LIC809 or LIC9099) for 30 days. If these requirements are not met, civil penalties in the amount of $500 per violation will be assessed. The applicant was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

The applicant has been informed that all employees and adults in the home must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $500.00, per day the person has been present, will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12-month period, the fine will continue for up to 30 days.

The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents.

Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Zero Tolerance Related Regulations from Family Child Care Homes were also discussed. This includes the following: Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. Civil penalty applies when a child is left unattended. Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: DILLARD-JACKKSON FAMILY CHILD CARE
FACILITY NUMBER: 197494467
VISIT DATE: 02/14/2020
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At this time, the facility does not provide Incidental Medical Services - IMS.

Incidental Medical Services (IMS) policy was discussed. 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. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.

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, available at: http://www.ada.gov/childqanda.htm.


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. Title 22 Regulations, Child Care Quarter Updates may be viewed at www.ccld.ca.gov.


LPA discussed discipline policies, personal rights, civil penalties and appeal rights. LPAs informed applicant of regulations regarding reporting unusual incidents and injuries within 24 hours.

Applicant was informed that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). The applicant was provided a handout on Safe Sleep. No smoking is allowed on a day care premises. Never shake a baby to prevent Shaken Baby Syndrome. Only children eating may be in high chairs. Applicant was notified that it is required to wash hands after every diaper change.



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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 6 of 6