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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412721
Report Date: 04/06/2023
Date Signed: 04/06/2023 06:16:20 PM

Document Has Been Signed on 04/06/2023 06:16 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 FAMILY CHILD CAREFACILITY NUMBER:
197412721
ADMINISTRATOR:JACKSON, YVONNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 779-2347
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:21 PM
MET WITH:Yvonne Jackson - LicenseeTIME COMPLETED:
06:22 PM
NARRATIVE
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On 4/6/2023 Licensing Program Analyst (LPA) Jillinda Chandler met with licensee Yvonne Jackson. During todays visit there were no children present and no other adults in the home. Per the licensee she has not provided care since approximately 3 years.
During todays inspection the licensee was advised regarding inactive status, licensee would like to consider inactive status. LPA will conduct an annual continuation should the licensee decide to maintain her licensing status.

The home was inspected for Health and Safety compliance,

Care and supervision was not being provided during todays visit.
Appropriate size fire extinguisher was observed in need of servicing, last inspected 1/2019.
Carbon and smoke detector present & operable.
Detergents, and knives were inaccessible.
No guns or weapons present as stated by the licensee, no weapons observed by LPA.
The home has a properly working telephone.
LPA observed the homes parent notification board; the license, facility sketch, Emergency Disaster Plan, Notification of Parent’s Rights Poster, Lead Poison Awareness, Safe Sleep and California Safety Seat Law were posted.
A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer. Licensee’s Pediatric CPR and First Aid Card expires 9/2023
Licensees Mandated Reporter certificate expires (4/23/2022) LPA observed a jacuzzi in rear pool room, the jacuzzi had a locked cover.
No children records were available for review.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 197412721
VISIT DATE: 04/06/2023
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Personal records were reviewed, LPA observed; immunization records for licensee, licensee was advised to provide immunization records for Measles, Mumbs, Rebella (MMR)
A roster was not readily available, there were no children enrolled during todays visit.
Licensee does not provide Incidental Medical Services (IMS). IMS was discussed with licensee.
All adults in the home cleared a Criminal Background Clearance.
no toys, equipment or materials were available and in good order

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 [email protected]. 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.

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.


LPA discussed the 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-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.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Yvonne Jackson

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
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Document Has Been Signed on 04/06/2023 06:16 PM - It Cannot Be Edited


Created By: Jillinda Chandler On 04/06/2023 at 05:46 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 197412721

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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 review of personnel records licensee did not have current Mandated Reporter Training potential safety risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
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Licensee shall take the Mandated Reporter Training no later than the due date of 4/14/2023. Licensee shall provide a copy of the training certificate via email, fax or text.
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.
SUPERVISOR'S NAME:Claudia Escobedo
LICENSING EVALUATOR NAME:Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023


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