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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495214
Report Date: 12/08/2022
Date Signed: 12/08/2022 12:05:10 PM

Document Has Been Signed on 12/08/2022 12:05 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 & THOMAS FAMILY CHILD CAREFACILITY NUMBER:
197495214
ADMINISTRATOR:DONNA JACKSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 793-0828
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Donna Jackson, ApplicantTIME COMPLETED:
12:15 PM
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On 12/08/2022, Licensing Program Analyst (LPA), Adrian Risher conducted a pre-licensing inspection for a family child care home. LPA met with applicant Donna Jackson and toured the facility. The applicant is the only individual present at the time of the inspection. LPA did not observe any children present. The home is clean, orderly and comfortable. All adults in the home have been fingerprinted. Co-applicant Derrick Thomas's fingerprints are still pending, The hours of operation will be 6:00am-6:00pm Monday thru Friday. Applicant is requesting to have a family child care home with a capacity of 14. Applicant confirmed phone number:323 793 0828. A fire clearance was granted on 10/20/2022.

The single family home has 2 bedrooms and 2 1/2 bathrooms. The daycare will consist of playroom area primarily but the children will have access to the whole home except Bedroom 1. These areas were inspected by LPA. Bedroom 1 is off-limits. Applicant will conduct daily activities, eating and napping in the playroom. LPA observed mats that will be used for napping. LPA observed age appropriate toys, furniture and activities for children while in care at the facility. Applicant owns the home. Applicant provided proof of control of property with the application.

LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children. Licensee has put safety latches on the lower cabinets in the kitchen and the bathroom. Bedroom 2 will be used as the isolation area for ill children.

LPA inspected the outside play area. LPA did not observe any bodies of water. The outside play area is gated all around. Applicant will place a gate next to the garage that prevents the children from going to the grassy area and the back of the garage.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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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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 & THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 197495214
VISIT DATE: 12/08/2022
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Applicant will purchase a larger fire extinguisher. LPA tested the smoke detector and carbon monoxide detector during inspection. Applicant has a first aid kit which includes band aids and a thermometer. The home has 2 screened heaters and applicant will screen the third one in the hallway. The home has air-conditioning units throughout the home.

Applicant has current CPR, first aid, health and safety which expires 11/2023. Applicants provided copies of immunization record and mandated report certificate with application. Applicants stated the firearms are stored in the locked box on the upper shelf in Bedroom 2's closet. Applicant reports there are 3 dogs in the home. One dog stays in the laundry room. The other 2 dogs are in the backyard locked behind a gate.



The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible.


The following corrections were discussed with applicant in order for the home to be ready for conducting child care:

1. Fire extinguisher 2 A 10 B C or larger
2. screen heater in hallway
3. gate in yard

A license to operate a Large Family child care home will be reviewed following final administrative review and receipt of outstanding corrections needed. No license will be issued today 12/08/2022. Applicant will notify LPA when corrections have been made and the Applicant has 30 days to complete corrections.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 & THOMAS FAMILY CHILD CARE
FACILITY NUMBER: 197495214
VISIT DATE: 12/08/2022
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LPA discussed the safe sleep regulations with applicant 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 applicant 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.

This facility plans to provide Incidental Medical Services – IMS. 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

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

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.

Exit interview conducted and report was reviewed with the applicant Donna Jackson

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
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