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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846050
Report Date: 10/03/2024
Date Signed: 10/03/2024 12:54:55 PM

Document Has Been Signed on 10/03/2024 12:54 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JACKSON FAMILY CHILD CAREFACILITY NUMBER:
334846050
ADMINISTRATOR/
DIRECTOR:		JACKSON,KAMILAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 215-5109
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 3DATE:
10/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Kamiliah Jackson, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 2024 at 8:10 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was greeted by Licensee Kamilah Jackson and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following: Present were the licensee and 1 adult resident and 1 staff. The licensee submitted updated LIC279 Application form, for changes to operation hours; Updated LIC999A Facility Sketches x2, and updated LIC610A Emergency Disaster Plan.

Normal days and hours of operation: Monday through Sunday; 4:30 AM to 11:30 PM
OFF-LIMIT AREAS INCLUDE: 1st Floor Bedroom #4, the laundry room, Garage, Entire 2nd Floor, fenced section of the backyard.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D.

· The facility is operating within the licensed capacity and appropriate ratios. LPA took a census of 3 children in care.
· The Licensee is present in the home and has ensured that children in care are supervised.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
· A working telephone is present.
· A fully charged fire extinguisher (2A:10BC) was observed and needle in the green, tagged 06/05/2024. A smoke detector and carbon monoxide detector were present and tested by the licensee during this inspection on 10/03/2024.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 334846050
VISIT DATE: 10/03/2024
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· All hazardous items ARE NOT inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children. LPA inspected the designated children’s restroom and observed cleaning supplies such as surface and toilet cleaners, bleach, hygiene supplies, razors unlocked and accessible to daycare children in a lower cabinet and medicine cabinet.
· Storage of poisons are NOT inaccessible to children and are NOT locked, where the LPA observed bleaches, cleaning supplies, kitchen knives, air fresheners stored on top of the refrigerator where school age children have access to the items and health supplements, in a lower kitchen cabinet where younger daycare children have access. Although daycare children were present during the inspection they were not observed in the areas where the poisons and toxins were located. The licensee removed the items in the presence of the LPA to relocate and store the hazardous items in the garage and laundry room which are designated as off-limits. Although the garage and laundry room are off limits the doors do not lock and remain accessible to daycare children. In addition, the LPA observed additional cleaning, automotive supplies, yard supplies and gym equipment such as weights in the garage and laundry room. Therefore the off-limit areas were determined to be unsecured areas to store poisons, toxins and/or other potential and/or immediate hazards.
· Stairs are barricaded on 10/03/2024.
· The fireplace is properly screened on today’s date.
· No guns or weapons present as stated by the Licensee Kamilah Jackson. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present.
· Verification of control of property on file by rental agreement.
· Property owner/landlord notification and consent on file.
· Pediatric CPR and First Aid training on 10/22/2023; Card expires on 10/2025
· Health & Safety Certificate - completed on 3/20/2020; Lead Poisoning Prevention on 8/24/2021
· Mandated reporter General: 01/28/2021; AB 1207 Child Care Expired on 01/28/2023; Licensee did not renew training.
· Fire clearance: 12/09/2021
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 06/05/2025
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 334846050
VISIT DATE: 10/03/2024
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· There are no bodies of water on 10/03/2024. The licensee Kamilah Jackson understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Children’s files are NOT complete; Missing Sleep Log, last log entry for subject child enrolled is 03/26/2024. Per licensee, they thought the sleep logs stop at 12 months, however the licensee was in violation of not having sleep logs during the last inspection date 01/23/2023.
· Staff’s files ARE NOT complete: A staff present missing proof of TB screening and Mandated Reporter Training. Per licensee the subject staff began employment on 09/09/2024. The subject staff provided proof of appointment for TB screening and the LPA reminded the licensee of the 90 day timeline for assistant to complete the Mandated Reporter Training.
· A review of staff records on 10/03/2024 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

For IMS information, see PIN 22-02-CCP. 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: http://www.ada.gov/childqanda.htm

The Licensee Kamilah Jackson, 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.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 334846050
VISIT DATE: 10/03/2024
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LPA Susan Brewer, discussed the safe sleep regulations with Licensee Kamilah Jackson and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA Susan Brewer, also informed Licensee Kamilah Jackson, 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A deficiencies were issued on today’s date for 2 Type B violations.

No civil penalties issued on today’s date.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Kamilah Jackson.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/03/2024 12:54 PM - It Cannot Be Edited


Created By: Susan Brewer On 10/03/2024 at 12:08 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 334846050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in the licensee stored hazaroudous, poisons and toxins such as cleaning supplies, health supplements, hygiene products, kitchen knives where accessible to daycare children in unclocked cabinets of the kitchen, restroom, laundry room and garage which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/11/2024
Plan of Correction
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The licensee agrees to ensure defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. The licensee agrees to submit proof that all hazards/poisons/toxins are secured in a locked area and submit proof by fax, mail or e-mail.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in the licensee was unable to provide proof of sleep logs for a subject child under 2 years of age, present and in care and by admission stopped logging for the subject child at 12 months of age, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/11/2024
Plan of Correction
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The licensee agrees to ensure documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check and/or other notes required during sleep checks. In addition, the licensee agrees to submit a written statement of understanding the safe sleep regulations and how they are implementing the safe sleep regulations for children under 2 years of age.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2024


LIC809 (FAS) - (06/04)
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