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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274405354
Report Date: 12/29/2022
Date Signed: 12/29/2022 12:56:58 PM


Document Has Been Signed on 12/29/2022 12:56 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:JACKSON, GRETCHENFACILITY NUMBER:
274405354
ADMINISTRATOR:JACKSON, GRETCHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 235-0776
CITY:SALINASSTATE: CAZIP CODE:
93907
CAPACITY:14CENSUS: 0DATE:
12/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Gretchen JacksonTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Elizabeth Larios met with Jackson Gretchen, Licensee, for an unannounced Required –1 year annual inspection. LPA was granted access to the home by the Licensee. LPA did not observed children in care during today's inspection. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 7:30 AM to 5:00 PM. Licensee is the only adult residing in the home.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection.The last fire/disaster drill was completed on October 5, 2022. Licensee does have liability insurance for the day care March 18, 2023. Licensee has a current CPR and First Aid certification (expiration: February 26, 2024). Licensee has the required vaccines (MMR, Tdap, & flu) and a current Mandated Reporter Training for Child Care Workers Certificate (expiration: October 04, 2024). LPA reviewed five children's files and the files were complete with the required forms. LPA reviewed one staff file (Licensee) and the file was complete with the required forms.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. The home is clean, orderly, (including heating/fans/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. LPA observed barricade fireplace in living room. The off limit areas inside the home is the stairs, upstairs floor plan, and garage. Backyard was observed with a fenced deck, and no bodies of water were observed.

LPA observed a fully charged 3A40BC fire extinguisher near the garage, working smoke/carbon monoxide detectors. The Licensee stated that there are no weapons/ firearms in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children and stored in the kitchen, and garage. Licensee states that she does not administer any medications to the day care children at this time.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JACKSON, GRETCHEN
FACILITY NUMBER: 274405354
VISIT DATE: 12/29/2022
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Licensee states that she provides breakfast, snacks (PM), and lunch, to the day care children. Licensee states that she understands that any food brought from home needs to be labeled with each child's name and properly stored. Licensee has a first aid kit in the home. Licensee states that nobody smokes and she understands that smoking is prohibited in the home.

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

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee states that a child will be isolated in the living room if necessary due to illness or communicable disease. Licensee states she does transport day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensee 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.

LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee 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.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JACKSON, GRETCHEN
FACILITY NUMBER: 274405354
VISIT DATE: 12/29/2022
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If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with the Licensee, Gretchen Jackson. No Deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC809 (FAS) - (06/04)
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