367700002-7-11-2019-12-CC-JNEL-BDYUNV-20190711154435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700002
Report Date: 07/11/2019
Date Signed: 07/11/2019 03:44:52 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:	367700002
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	07/11/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Otechia Jackson		TIME COMPLETED:	04:00 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) Neal met with Licensee, Otechia Jackson for the purpose of a Case Management - Licensee Initiated inspection for a Capacity Increase. Licensee has 3 foster children residing in the home. There were 5 child care children present during this inspection. The home was inspected for safety, comfort, cleanliness, telephone service, central air and heat and ventilation. Also for inaccessibility to poisons, detergents, cleaning compounds, medicines, and other hazardous items that can pose a danger to children. Child care activities are conducted in the living room/dining area. Children will use the bathroom down the hall to the right, across from the bedrooms. Off limits areas include all bedrooms (key locked), laundry room (key locked) and garage (key locked). Sharp knives are stored in child-locked kitchen pantry. Medications are stored in the locked master bedroom. Off limits garage is accessed through the locked laundry room, down the hall from the bathroom. Cleaning compounds and detergents are stored in the laundry room. Licensee has 1 small dog. Parent board was observed at the entrance with all required documents posted. LPA observed age appropriate toys and equipment. There is no pool, spa or bodies of water on the premises. Upcoming regulations on safe sleep were discussed. Safe sleep concepts handout was given. Children play outside in the backyard. There is a large play structure with swings and wood chips underneath and a concrete area for active play.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

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: 367700002
	VISIT DATE: 07/11/2019

NARRATIVE

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**Licensee is aware if she or assistant is alone with any children, she then reverts to a small family child care. Licensee also understands the ratio and capacity requirements of the small and large family child care license. Licensee understands that any adult alone caring for children must have a background check clearance, immunizations, current Pediatric 1st Aid and CPR certificates and current Mandated Reporter training with certificate on file.

Licensee has current Pediatric CPR/First Aid certification, set to expire November 2019.

Licensee was advised to regularly visit the Department's web site: www.ccld.ca.gov to review Title 22 regulations and the California Health & Safety Codes for a Family Child Care Home.

Fire clearance was granted on 6/26/2019.

No deficiencies were cited during this inspection.

LIC 9213- Notice of Site Visit was given to licensee to be posted. Notice of Site Visit must remain posted for 30 consecutive days. Failure to do so will result in an immediate civil penalty assessment of $100.

The increase of capacity for a Large Family Child Care Home will be submitted for approval. Exit interview was conducted, report was read and a copy of the report was given to the licensee.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

LIC809 (FAS) - (06/04)

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