364842697-8-8-2019-12-CC-JNEL-BEUQ7M-20190808115522

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364842697
Report Date: 08/08/2019
Date Signed: 08/08/2019 11:55:32 AM

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:	WALKER-JACKSON FAMILY CHILD CARE HOME		FACILITY NUMBER:	364842697
ADMINISTRATOR:	WALKER-JACKSON, YASHIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 987-7605
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	14	CENSUS: 7	DATE:	08/08/2019
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Yashika Walker-Jackson		TIME COMPLETED:	12:10 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 Analysts (LPAs) Neal and Mabika met with licensee, Yashika Walker-Jackson for the purpose of a Random inspection. This is a two story 5 bedroom, 5 bathroom home with kitchen/dining room, living room, backyard, laundry room, and garage. The garage is used for storage only and no child care activities are conducted there. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 2 adults (licensee, spouse) and 7 children. There were no care children present during this inspection. Incidental Medical Services (IMS) policy was discussed. Main care is provided in the living and family room. Children use the bathroom located down the hallway on the left. Off limit areas include the gated upstairs area, all 5 bedrooms (key lock), the other 4 bathrooms, laundry (key lock) and the garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Medicines are kept in an upper cabinet in the kitchen cabinet inaccessible to children. Sharp knives are in the kitchen above the microwave. Cleaning compounds and detergents are stored in the pantry and locked laundry room, inaccessible to children. Facility roster was observed. Licensee has 1 small dog.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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: WALKER-JACKSON FAMILY CHILD CARE HOME	FACILITY NUMBER: 364842697
	VISIT DATE: 08/08/2019

NARRATIVE

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Children play in the backyard . There are rubber mats area for active play and age appropriate toys. Backyard is fenced. There is no pool or spa on the premises.
Per licensee, there are no weapons or firearms of any kind in the facility. The LPAs did not observe any weapons. LPAs observed age appropriate toys and equipment on the premises. The required carbon monoxide detector and smoke detector are in operable condition. Fireplace is properly screened and blocked off from the children. Home has central AC and heat. Licensee has a First Aid kit. LPAs observed required documents are posted. A sample of children's files were reviewed. Licensee was reminded that Mandated Reporter training for child care must be completed by licensee and any adults assisting at the child care at the website, www.mandatedreporterca.com, every 2 years.

The following was discussed with the licensee:
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 reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. 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 child 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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: WALKER-JACKSON FAMILY CHILD CARE HOME	FACILITY NUMBER: 364842697
	VISIT DATE: 08/08/2019

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Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12 month period, PER PERSON.
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 was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

2 Type B deficiencies were cited during this inspection. LIC 809D was provided. Appeals rights were also given.
Exit interview was conducted and a copy of report was read and provided to Licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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: WALKER-JACKSON FAMILY CHILD CARE HOME	FACILITY NUMBER: 364842697
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/30/2019 Section Cited HSC 1596.866	1 2 3 4 5 6 7	Additional health and safety training; condition of licensure. Training in pediatric first aid and pediatric CPR by persons described in subdivisions (a) and (b) shall be current at all times. Requirement is not met as	1 2 3 4 5 6 7	Licensee stated in-person pediatric CPR/First Aid class will be completed and proof of completion sent to Palmdale RO by plan of correction due date.
	8 9 10 11 12 13 14	evidenced by: licensee does not have proof of current pediatric CPR/ First Aid training. Licensee's CPR/First Aid completed 4/5/19 was done online which is a potential risk to the heath and safety of children.	8 9 10 11 12 13 14
Type B 08/30/2019 Section Cited CCR 102417(g)(1)	1 2 3 4 5 6 7	The home shall be free from defects or conditions which might endanger a child... The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement was not met as	1 2 3 4 5 6 7	Licensee states she will have fire extingusher serviced and notify Palmdale RO by POC due date.
	8 9 10 11 12 13 14	evidenced by: fire extinguisher in the home needs serviced, LPAs observed fire extingusher needing charged. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

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