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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203911509
Report Date: 04/04/2025
Date Signed: 04/04/2025 11:25:45 AM

Document Has Been Signed on 04/04/2025 11:25 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WOODS/JACKSON FAMILY CHILD CAREFACILITY NUMBER:
203911509
ADMINISTRATOR/
DIRECTOR:		WOODS,KIME/JACKSON,JAMESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 353-1277
CITY:MADERASTATE: CAZIP CODE:
93636
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Kime WoodsTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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On 04/04/2025 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez conducted an unannounced Annual Required inspection and was met by licensee, KIME JACKSON. Days and hours of operation are Monday through Friday from 7:00pm to 7:00am.

LPA had attempted to conduct an unannounced inspection on the following days 12/11/2024, 01/08/2025, and 01/14/2025.

LPA toured the home inside and outside. No children were present during the inspection. Current facility sketch was reviewed, and Licensee confirmed the Next Gen private suite, that consists of a kitchenette, living/dining room area, a bedroom and bathroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by door lock.

There is a built in-ground swimming pool in the backyard which is fenced. LPA was informed by licensee that in-ground pool was built in December of 2024, yet the Department was not made aware of the changes. LPA observed three (3) windows that open towards the pool (picture taken). LPA observed that a section of the mesh fence has a gap that has a diameter that is greater than four (4) inches (picture taken). LPA observed that there is an outdoor surface area/physical characteristic that can be used has a foothold that could enable a child to climb over to the pool (picture taken). LPA was not able to confirm if mesh fence is ASTM approved. LPA observed a pool alarm, yet licensee was unable to provide information that it is ASTM 2208 approved. Licensee did not have a life ring or a rescue pole. LPA observed that fence is 60 inches in length, LPA observed that the pool door opens away from the pool and self closes.

(Continue on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Stephanie Vega-Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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Document Has Been Signed on 04/04/2025 11:25 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 04/04/2025 at 10:22 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WOODS/JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 203911509

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.814(a)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that in-ground pool did not abide by Title 22 Regulations as stated in the LIC809 Report, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2025
Plan of Correction
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Licensee stated they will submit a letterhead stating in description on what actions will be taken to make corrections and approximately how long it will take to make corrections. Licensee will review bodies of water regulations and write a statement on what they have learned and submit it to the Department by POC due date.
A future inspection will be conduct to ensure that pool abides by Title 22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Cynthia Brannon
NAME OF LICENSING PROGRAM MANAGER:
Stephanie Vega-Gonzalez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2025


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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WOODS/JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 203911509
VISIT DATE: 04/04/2025
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LPA observed that interior sliding door of the home had an alarm that sounded when door was open. LPA reviewed bodies of water regulations with licensee and provided copies of PIN 25-01-CCP 2024 Chaptered Legislation Affecting Child Care Facilities and a copy of the AB2866. LPA advised licensee that effective 1/1/25 they are required to adhere to AB 2866 – Pool Safety: State Department of Social Services regulated facilities as they are no longer exempt from the Swimming Pool Safety Act. The Health and Safety Code requirements are included in Section 1596.814. A Provider Information Notice (PIN) has been published.

Licensee stated that there are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is one electric fireplace that is located in the main part of the home and Licensee stated that it will not be used during day care hours. There is a working fire extinguisher (Size/ 2A:10BC), smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are barricaded when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 353-1277.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Licensee informed LPA that she uses the front yard for children in care. Licensee stated she understood that children must be fully supervised at all times when children are playing in the front yard of the home. Capacity as specified on the license is being maintained.

Since there were no children enrolled LPA reviewed a children’s files with licensee. Licensee’s Mandated Reporter Training was completed on 2/19/2025. Licensee’s pediatric CPR/First Aid certification expires on 6/24/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

(Continue on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Stephanie Vega-Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WOODS/JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 203911509
VISIT DATE: 04/04/2025
NARRATIVE
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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.

No infants enrolled at this time. LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

Exit interview conducted and report was reviewed with licensee. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

(Continue on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Stephanie Vega-Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WOODS/JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 203911509
VISIT DATE: 04/04/2025
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Per Title 22, Division 12, and Chapter 3 of the California Code of Regulations, the following deficiencies are being cited: (see next page).

Licensee was provided appeal rights.

LPA Vega-Gonzalez informed licensee that this report dated 04/04/2025 has one (1) Type A citation. Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care. Also, LPA Vega-Gonzalez informed the licensee to provide a copy of this licensing report dated 04/04/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee.

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Cynthia Brannon
NAME OF LICENSING PROGRAM ANALYST: Stephanie Vega-Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/04/2025 11:25 AM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 04/04/2025 at 10:45 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WOODS/JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 203911509

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that licensee did not report to the Department about changes that occurred in the home. Licensee had built a in-ground pool, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/18/2025
Plan of Correction
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Licensee stated that they will review regulation 102416.3 Alterations to Existing Buildings or Grounds and write a statement on what they have learned and submit it to the Department by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Cynthia Brannon
NAME OF LICENSING PROGRAM MANAGER:
Stephanie Vega-Gonzalez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2025


LIC809 (FAS) - (06/04)
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