197493431-9-1-2026-30-CC-LCLN-DXHRCM-20260901125434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493431
Report Date: 09/01/2026
Date Signed: 09/01/2026 12:55:20 PM

Document Has Been Signed on 09/01/2026 12:55 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	JACKSON FAMILY CHILD CARE		FACILITY NUMBER:	197493431
ADMINISTRATOR/ DIRECTOR:	JACKSON, KERISHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 334-9215
CITY:	GARDENA	STATE: CA	ZIP CODE:	90249
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	09/01/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	KERISHA JACKSON, LICENSEE		TIME VISIT/ INSPECTION COMPLETED:	01:15 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

On 09/01/2026 Licensing Program Analyst (LPA), Lisa Clayton arrived unannounced at the Jackson Family Child Care home to conduct an Annual Random Inspection. LPA Clayton was greeted by Kerisha Jackson. This inspection is being conducted to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

LPA Clayton toured the home inside and outside and observed 6 children in care. Capacity as specified on the license is being maintained during today’s inspection. LPA confirmed via Guardian roster that all individuals living and/or working in the home have a criminal record clearance.

Licensee provides care to children ages 2 months - 12 years of age. Operating hours are Monday – Saturday, 7:30 a.m. – 5:00 p.m. Licensee provides breakfast, lunch, pm snack, water and/or milk as needed. Upon entering the home, LPA Clayton observed the Parent board in a prominent, publicly accessible area.

LPA confirmed that the single-family home consists of the following: living/dining room, kitchen, 3 bedrooms, 2 full bathrooms, attached garage, and fenced backyard.

The ON-LIMITS areas are the living/dining room (main day care area), bathroom #1, bedroom #2 (napping room), and the fenced backyard. The ISOLATION AREA is in the living room.

The OFF-LIMIT AREAS are as follows: bedroom #1, bedroom #3, bathroom #2, and detached garage, all of which are made inaccessible to children in care by child safety gates, closed and/or locked doors and visual supervision.

Karren Starks
Lisa Clayton
	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 197493431
	VISIT DATE: 09/01/2026

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
26
27
28
29
30
31
32

LPA observed age-appropriate toys and materials for children to use as well as age-appropriate napping equipment. The home is neat and clean with heating and ventilation for safety and comfort. The home has a working phone, and LPA Clayton confirmed the number is 310-334-9215.

The home has a fully charged 2-A:10-B:C Fire extinguisher in the kitchen, a working smoke detector in the napping room and a working carbon monoxide detector in the hallway. LPA Clayton suggested to licensee that she install a carbon monoxide/smoke detector combo in the main day care area.

LPA observed a log indicating that disaster drills are conducted and documented as required.

Per the licensee, there are no firearms in the home. Any detergents, cleaning compounds, medication, poisons, and other hazardous items are inaccessible to children. There are no pools, ponds or other bodies of water on the property.

LPA Clayton reviewed 6 children’s files and observed the files containing immunization records, contact information of parents and authorized representatives, signed Parent’s Rights. Files were missing blue cards. LPA Clayton provided licensee with Blue Cards as well as the phone number for the CA Department of Public Health to order more cards.

Licensee provided LPA Clayton with proof of payment for a CPR/First Aid class on Thursday September 3, 2026, and will forward a copy of the certificate of completion for both the CPR/First Aid and Mandated Reporter to the department immediately upon completion, no later than Monday, September 7, 2026. The Assistants CPR/First Aid and Mandated Reporter expire October 2027.

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.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Lisa Clayton
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JACKSON FAMILY CHILD CARE	FACILITY NUMBER: 197493431
	VISIT DATE: 09/01/2026

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
26
27
28
29
30
31
32

LPA Clayton reminded licensee of the safe sleep regulations 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 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.

Incidental Medical Services (IMS) are not being provided at this time. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. LPA Clayton provided licensee with an IMS Plan sample. 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

During the exit interview, the Licensee Kerisha confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA Clayton instructed licensee Kerisha to: · Update children’s immunizations records using the CDPH 286, per Title 22 regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations and Health & Safety codes, no Deficiencies were cited, Technical Violations were issued.

An exit interview was conducted, and a copy of this report was read and provided to the Licensee Kerisha. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Lisa Clayton
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC809 (FAS) - (06/04)

Page: 4 of 6