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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494556
Report Date: 06/30/2022
Date Signed: 06/30/2022 04:31:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2022 and conducted by Evaluator Lillian J Casillas
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220624160122
FACILITY NAME:JACKSON AND JACKSON FAMILY CHILD CAREFACILITY NUMBER:
197494556
ADMINISTRATOR:JACKSON, TENIKA & NYEMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 500-7126
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:14CENSUS: 0DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Tenika JacksonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee is providing care and supervision at an alternate location
INVESTIGATION FINDINGS:
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On 6/30/2022 at 8:40AM, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced 10-day complaint visit for the purpose of initiating the investigation for the above allegation. LPA observed the facility to be closed. At 11:15AM, LPA returned to the facility and, again, no one answered the door.

LPA Casillas reviewed the advertisement for the child care home on WeeCare, which advertises her license number at a commercial property. LPA arrived at 8946 Sepulveda Eastway Los Angeles, CA 90045. Upon arrival, LPA met with Adult 1 who called Licensee, Tenika Jackson. Licensee stated she did not “renew” her license and is has not provided child care at the family child care home since the third week of May 2022. LPA explained the process of surrendering a license. Licensee stated she wishes to surrender the license effective 6/30/2022. LPA issued a Notice of Operation in Violation of the Law letter for the unlicensed facility located at 8946 Sepulveda Eastway Los Angeles, CA 90045.

[CONTINUE ON PAGE 2]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 30-CC-20220624160122
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 AND JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 197494556
VISIT DATE: 06/30/2022
NARRATIVE
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PAGE 2

Based on observation, record review, and interviews, there is a is a preponderance of evidence to prove that the allegation of unlicensed care is SUBSTANTIATED. Per Licensee’s admission, the facility is not providing child care; instead, child care is being provided at 8946 Sepulveda Eastway Los Angeles, CA 90045, which is an unlicensed location. A Type A deficiency was cited during today's inspection (see LIC9099-D for details).

Upon receipt of this report, the Licensee shall post the Notice of Site Visit (LIC 9213) and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224) form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).

An exit interview was conducted. A copy of this report was provided to Licensee, Tenika Jackson, via email along with Appeal Rights and Notice of Site Visit. Licensee agrees to the email, stating the report was received and read in lieu of a signature.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 30-CC-20220624160122
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 AND JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 197494556
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/30/2022
Section Cited
CCR
102368(b)
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102368 License (b) The license shall not be transferred to other individuals or locations.

This requirement was not met as evidenced by:
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Licensee agrees to surrender her license and cease operation at 8946 Sepulveda Eastway Los Angeles, CA 90045. Licensee agrees to remove advertisement from WeeCare effective 6/30/2022. Licensee has the option to apply for a child care center within 15 days.
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Based on observation, record review, and interviews, Licensee is operating a child care program at an unlicensed location that is advertized using the license number, which poses an immediate health, safety, or personal rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3