198008356-7-20-2022-54-CC-KCHE-CGHVXB-20220720164916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198008356
Report Date: 07/07/2022
Date Signed: 07/20/2022 04:49:24 PM

Document Has Been Signed on 07/20/2022 04:49 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	JACKSON FAMILY CHILD CARE		FACILITY NUMBER:	198008356
ADMINISTRATOR:	JACKSON, LIZZIE AND JOHN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(424) 785-7561
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	14	CENSUS: 12	DATE:	07/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Lizzie Jackson, Licensee		TIME COMPLETED:	04:15 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)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 07/07/2022 at 11:45 AM. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Lizzie Jackson, who guided the LPA on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. Also present were two Assistants who have criminal record clearance. There were 12 day care children present during today’s inspection, ten children and two infants. Licensee states that there are currently 14 children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 24 hours. LPA discussed with Licensee limitations of not providing care for a child longer than 23 hours. LPA discussed Overnight Care procedures with Licensee. Licensee states she has cots and air mattresses available and children will use Daycare Room in the back. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 06/19/2022. This is a single-story home which consists of two bedrooms and one bathroom, Kitchen, Living Room, and Daycare Room. Areas used by the children include the Living Room (located upon entry of the home), which Licensee states is for K-12, Bathroom 1 (located through hallway towards rear of home), and Daycare Room (located in the rear of the home). Per Licensee, areas off limits to children and parents include all bedrooms and Kitchen. Per Licensee, Bedroom 2 is only used as a walkway to Daycare Room. At 11:55 AM, LPA observed that Bedroom 1 has a child safety door knob cover. At 12:18 PM, LPA observed sliding pocket door closed blocking access to Kitchen. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. At 11:57 AM, LPA observed wall heater in Living Room and hallway leading to bathroom that is covered making it inaccessible to children in care. There is a working telephone maintained in the home. At 11:54 AM, LPA observed Living Room to Report continues- Page 1 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 198008356
	VISIT DATE: 07/07/2022

NARRATIVE

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have two sofas, book shelf, and child size tables and chairs available. At 11:56 AM, LPA observed Bathroom 1 to have operable toilet and sink, under cabinet sink and medicine cabinet to be free of hazards, and adequate handwashing and toileting supplies at time of inspection. At 11:58 am, LPA observed Daycare Room to have cubbies for child's belongings, dramatic play toys, art materials, books, and other age appropriate toys, free of loose and sharp parts. Per Licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock. Licensee states these items are kept in storage cabinets that LPA observed to have operable child safety locks. Per Licensee, they provide food for children in care.

Per Licensee, the children will have access to backyard area for outdoor play. LPA observed backyard is accessible through backdoor in Daycare Room. At 12:00 PM, LPA observed the children coming into Daycare Room from having water play outside. At 12:02 PM, LPA observed outdoor play area to have large inflatable water play climbing structure with slide. Licensee's Assistant says they empty the water when not in use and LPA observed inflatable water play structure to be deflated and water emptying at time of inspection. At 12:03 PM, LPA observed large trampoline with safety netting and zipper that is well maintained. At 12:04 PM, LPA observed shaded area with small trampolines well maintained. LPA observed bicycles, ride along toys, plastic playhouse tetherball structure, large basketball net, small plastic play structure with slide and cushioning below, and plastic crawl tube and infant area, and other age appropriate toys free of loose and sharp parts available for the children in the backyard. LPA observed backyard has grass/dirt area, cushioning material under play structures, trees, shrubs, and plants are maintained with adequate perimeter fencing through-out the yard.

Per Licensee, there are no weapons, firearms in the home and LPA did not observe any firearms and/or weapons. Licensee states sick/isolation area is in Living Room. LPA observed PPEs and sanitation equipment in Living Room.

At 12:00 PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with service tag dated: 04/26/2022. At 12:07 PM, LPA observed smoke and carbon monoxide detectors are in

Report continues- Page 2 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 198008356
	VISIT DATE: 07/07/2022

NARRATIVE

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operable condition at time of inspection. Per Licensee, First Aid kit is kept in the Daycare Room, LPA observed First Aid kit and was inventoried for necessary supplies. The Licensee and Assistants has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection for all personnel. The Licensee and Assistants has also taken the
Mandated Reporter Training
—CPR Card valid until: 08/2023
—Mandated Reporter AB1207 Completed: 07/09/2021
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following were discussed:
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. 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

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

Report Continues - Page 3 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 198008356
	VISIT DATE: 07/07/2022

NARRATIVE

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The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

Senate Bill 792: this bill, commencing September 1, 2016, 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.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 07/07/2022.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Lizzie Jackson.

Report Ends - Page 4 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

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