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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494556
Report Date: 07/06/2022
Date Signed: 07/06/2022 12:58:06 PM

Document Has Been Signed on 07/06/2022 12:58 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:JACKSON AND JACKSON FAMILY CHILD CAREFACILITY NUMBER:
197494556
ADMINISTRATOR:JACKSON, TENIKA & NYEMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 500-7126
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
07/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:37 AM
MET WITH:Tenika Jackson LicenseeTIME COMPLETED:
01:15 PM
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On 7/06/2022 at 11:37am, Licensing Program Analyst, Adrian Risher and LPM Maureen Neal conducted a case management inspection regarding licensure. LPA met with the licensee Tenika Jackson and informed her the purpose of the inspection. LPA observed 12 children present with 4 staff.

The department received information from the licensee in May 2022 that she intended to forfeit the license and relocate elsewhere, however the department did not receive the license from the licensee indicating that she intended to close. LPA Risher and LPM Neal asked the licensee if she still had control of property. The licensee informed that she intends to sell the home however she has not sold the home yet and is still in possession of the home. The licensee stated she has secured a lease on a commercial building and has been in communication with building and safety on obtaining an approval. LPM discussed the processes of child care licensure informing the licensee that she must obtain a full approval form building and safety and then submit her licensing packet to Community Care Licensing (CCL). Licensing exemption information was given to the licensee. The licensee informed LPA & LPM she understands the processes and will contact the department if she has any further concerns.

No deficiencies were observed on today’s inspection.

An exit interview was conducted with Licensee Tenika Jackson. Appeal rights were provided.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2022
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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