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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423590
Report Date: 04/03/2024
Date Signed: 04/03/2024 10:04:28 AM

Document Has Been Signed on 04/03/2024 10:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:JACKSON, LAHOMAFACILITY NUMBER:
013423590
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
04/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:LAHOMA JACKSONTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
10:05 AM
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On April 3, 2024 at 9:15am Licensing Program Analyst (LPA) Janai McClain met with Licensee Lahoma Jackson for an increase in capacity inspection. Licensee resides alone in the home. Operating days and times are Monday through Saturday 6:00am-6:00pm.

Indoor Space: At 9:25 AM a health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is a multi-level house consisting of 3 bedrooms, 2 bathrooms, living room, dining room, eat-in kitchen, and family room. There is heating and ventilation for the safety and comfort of children in care.


Outdoor Space: At 9:30 AM LPA toured the outdoor area (backyard) and observed it was fenced. LPA observed there are no pools, hot tubs or other bodies of water. LPA observed the rear portion of the backyard is blocked off to prevent access to children in care. LPA observed a small trampoline. Licensee was reminded that 100% visual supervision is required when day care children use the outdoor area as well as to always follow the manufacture guidelines when day care children use the trampoline. There does not appear to be any dangerous hazards in the backyard such as poisons or toxins during today's inspection. OFF-LIMIT areas are the entire upper level of the home, the living room, dining room, eat-in kitchen, and the rear area of the backyard. LPA observed these areas are kept inaccessible by closed and/or locked doors; child proof gates and visual supervision. Stairs are blocked with child proof gates. IN-USE family room (on lower level), bathroom on lower level and backyard is used as the primary areas for day-care. Isolation area for sick children is the downstairs bedroom.

See 809C

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JACKSON, LAHOMA
FACILITY NUMBER: 013423590
VISIT DATE: 04/03/2024
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The home recently completed a required one year inspection on 7/13/23. LPA did a walk through of the home and observed a pull down fire alarm in the kitchen, a working smoke/carbon monoxide detector in the kitchen and a 3A40BC fire extinguisher in the lower level family room.

On 03/28/24, a fire clearance was granted to facility by Oakland Fire Protection Department. All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.


As of 4/3/24 the home has been approved to operate as a large family day care license.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Exit interview conducted with licensee Lahoma Jackson.

Report, Appeal Rights and Notice of site visit provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
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