197700265-5-20-2019-12-CC-CYAS-BCD23K-20190520170227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700265
Report Date: 05/20/2019
Date Signed: 05/20/2019 05:04:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	JACKSON FAMILY CHILD CARE		FACILITY NUMBER:	197700265
ADMINISTRATOR:	JACKSON, LARHONDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 291-7050
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 0	DATE:	05/20/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:17 PM
MET WITH:	LaRhonda Jackson		TIME COMPLETED:	05:15 PM

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	Licensing Program Analyst (LPA) Claretta Yates conducted an announced visit at the Jackson Home for the purpose of conducting a Pre-Licensing Inspection for a Family Child Care Home license. LPA met with LaRhonda Jackson (applicant). Pet applicant currently residing in the home is the applicant and 4 minor children. (see Confidential Name form (LIC 811) dated 05/20/19. The applicant is interested in providing care for a Large Family Child Care with the capacity of 14 children. Applicant has a Resource Family Approval Certificate with the Department of Children and Family Services (DCFS) for the capacity of 2 children. Approval date 07/29/18. (19W004353). The home is set up as follows: This is a two story home with 4 bedroom, 2 1/2 bathrooms, kitchen/dining, living room, family room, laundry room and attached garage. There is appropriate furnishings in the home. There is a fireplace in the living room made inaccessible to children with a glass/screen barrier. Applicant was informed that she shall ensure the safety of the children at all times. Applicant states she will be utilizing the family room, one bathroom (down stairs) family room, dining room, kitchen, living room, and the backyard for the Family Child Care. Per Applicant the off-limits area of the home will be the entire upstairs, 4 bedrooms and 2 full bathroom, down stairs laundry room and garage. LPA observed appropriate toys, small tables, chairs, and play equipment. All electrical outlets are covered.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 197700265
	VISIT DATE: 05/20/2019

NARRATIVE

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The kitchen and bathroom were inspected for proper storage of all cleaning detergents, medications, and sharp pointed objects which are made inaccessible to children with child safety locks on the cabinet and drawers. The hot water was tested at a safe temperature between 105-120 degrees. The smoke alarms and carbon monoxide device tested operable. The trash is covered with a tightly fitted lid. There is a fire extinguisher which meets the Fire Marshal standards available and a complete first aid kit with supplies and first aid manual. Applicant states there are no gun or weapon on the premises. The outside backyard play area is fenced and shaded patio available. There is an air conditioning unit with sharp blades accessible to children. There is no pool or bodies of water on the premises. . The home has working telephone service available.
Applicant has current Pediatric CPR, and First Aid Training with the expiration date of 05/16/2021 and 8 hours of Preventive Health and Safety Training. Applicant has completed the On-Line Mandated Training AB1207 dated 06/18/18. Applicant states she will be providing transportation, Applicant has a valid driver license, expiration date 07/03/2020, vehicle insurance expiration date 02/15/2020 and registration with expiration date 02/12/2020.

The following information was discussed and provided to applicant:
**Incidental medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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, available at http://www.ada.gov/childqanda.htm
**Applicant is aware that all adults 18 years and older living in the home or visiting for extended periods of time should have criminal background clearances with the Department of Justice and or associations, failure to comply will result in Civil Penalty assessments.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 197700265
	VISIT DATE: 05/20/2019

NARRATIVE

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Applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care.

**§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.

Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation.

Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to. Applicant is aware of required forms for children's files and forms that shall be posted after being licensure.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 197700265
	VISIT DATE: 05/20/2019

NARRATIVE

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Applicant is made aware that Title 22 Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban).
**State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
**Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were discussed. Applicant is made aware that 100% supervision is required at all times to children in care.
**§1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
(b) (1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
**Applicant was informed of the Requirement to report any Unusual Incidents/Injuries - within 1 day verbally and 7 days written.

Prior to being licensed the following is required:
· LPA shall check previous facility association (compliance history)

Backyard is off-limits to Day Care children until the air conditioning sharp blades are made inaccessible to children.

Exit Interview conducted a copy of this report was discussed and left at the facility

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

LIC809 (FAS) - (06/04)

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