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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842697
Report Date: 07/15/2021
Date Signed: 07/15/2021 05:35:36 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WALKER-JACKSON FAMILY CHILD CARE HOMEFACILITY NUMBER:
364842697
ADMINISTRATOR:WALKER-JACKSON, YASHIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 987-7605
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Yashika Jackson-WalkerTIME COMPLETED:
12:06 PM
NARRATIVE
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On 7/15/2021, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1 Year inspection at the above facility. Upon arrival LPA Heath was greeted by licensee, Yashika Walker-Jackson. LPA observed 3 preschool age child and 3 school age children. LPA observed Child Care Facility Roster. LPA observed 3 children files contained all required licensing documents. Per Licensing Information System, facility annual fees were current. The licensee is operating within proper capacity and ratios. Hours of operation are Monday though Friday, 5:00 AM to 12 AM.

This is a two story 5 bedroom, 5 bathroom home with kitchen/dining room, living room, backyard, laundry room, and garage. There is no pool or other bodies of water on the premises. Family members residing in the home include 2 adults (licensee, spouse) and 7 children. There were 7 children present during this inspection. Incidental Medical Services (IMS) policy was discussed.



Main care is provided in the 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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WALKER-JACKSON FAMILY CHILD CARE HOME
FACILITY NUMBER: 364842697
VISIT DATE: 07/15/2021
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Outdoor area: LPA Heath observed broke toys, trash, broken fense with nails that sticks out, 2 BBQ Grills, bikes, empty cardboard boxes, AC/Heating Unit was observed. LPA observed sharp blades is accessible to the children. There is no cover on top of the A/C system etc. all accessible to children.

LPA observed working smoke detector and Carbon Monoxide, fully charged fire extinguisher (2A10BC) which meet standards by the State Fire marshal and working telephone. There are several age appropriate toys and a first aid kit on the premises. Per the licensee, there are no firearms on the premises. The licensee has current CPR and first aid that expires October 1, 2021.

The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and will renew 10/27/2021. All childcare employees must complete mandated reporter training within 30 days of hire and renew training every two years

The licensee has the required immunization.


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

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WALKER-JACKSON FAMILY CHILD CARE HOME
FACILITY NUMBER: 364842697
VISIT DATE: 07/15/2021
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The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

Per the licensee, fire and disaster drills are conducted every month; last drill documented and conducted on 6/15/2021

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394).

The following was discussed with the licensee:

Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. Licensee was reminded that supervision is always required to children in care.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare 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.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WALKER-JACKSON FAMILY CHILD CARE HOME
FACILITY NUMBER: 364842697
VISIT DATE: 07/15/2021
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--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
-- Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

LPA provided consultation during the inspection.

The following Type B deficiencies (See LIC 809D) were cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

An exit interview was conducted, a copy of this Report and a Notice of Site visit were provided to the licensee.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WALKER-JACKSON FAMILY CHILD CARE HOME
FACILITY NUMBER: 364842697
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2021
Section Cited

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102417 Operation of a Family Child Care Home: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not meet as evidenced by: Based on observation and interview, LPA observed
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observed broke toys, trash, broken fense with nails that sticks out, 2 BBQ Grills, bikes, empty cardboard boxes, AC/Heating Unit was observed. LPA observed sharp blades is accessible to the children. There is no cover on top of the A/C system etc. all accessible to children which poses a potential risk to the health and safety of 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.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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