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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844287
Report Date: 09/30/2026
Date Signed: 09/30/2026 01:24:25 PM

Document Has Been Signed on 09/30/2026 01:24 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:JACKSON FAMILY CHILD CAREFACILITY NUMBER:
364844287
ADMINISTRATOR/
DIRECTOR:		JACKSON, LATOYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 373-6251
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/30/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:51 AM
MET WITH:Latoya Jackson, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On Wednesday, September 30, 2026, Licensing Program Analyst (LPA) Sara Rajapakse conducted an unannounced annual inspection and met with licensee, Latoya Jackson, who granted access and guided LPA on a tour of the facility. LPA verified that all adults currently residing or working in the home received a background clearance. Operating hours are Monday to Friday from 6:00 am to 6:00 pm and care is provided for children ages 0 to 12 years old. LPA observed no children in care. LPA observed facility to be within ratio. Annual fee is current. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children currently require IMS. Licensee provides transportation. LPA observed driver’s license, insurance and registration to be current. There is a pool on premise.

This facility is a two-story home with six (6) bedrooms and three (3) bathrooms, kitchen, laundry room, dining area, living room, family room with fireplace, entrance den, attached garage, front and backyard.

Areas off-limits to children include- six (6) bedrooms and bathrooms #2 and #3, kitchen, laundry room, front and partial backyard.

Areas accessible to children include- bathroom #1, dining area, living room, family room with fireplace, entrance den, front and partial backyard.

LPA inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, facility has central AC/heater. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. Electrical outlets were covered. LPA observed napping cots to be in good condition. LPA observe child safety gate at the bottom of the stairs in this two-story home. LPA observed a fireplace with glass doors and inaccessible to children.

Lady King
Sara Rajapakse Montolla
DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 364844287
VISIT DATE: 09/30/2026
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Bathroom #1: LPA observed the toilet and sink to be clean and operable. There is liquid hand soap by the sink. LPA did not observe hazard materials or medication. LPA reminded licensee any personal items (ex; shampoo, mouthwash, bar soap, medication, perfumes, razor blades, air fresheners, nail polish/remover or items that state keep out of reach of children) must be made inaccessible to children.

Backyard: LPA inspected the backyard play area for safety, comfort, and cleanliness. LPA observed the backyard to be fenced, and the side gate closed and locked with a self-latch. A portion of the backyard was inaccessible to children with a fence with a lock. The surface of the outdoor activity space is a combination of concrete and grass and it is maintained in a safe condition. LPA observed play equipment to be age appropriate and in good condition. The backyard is free of hazards. The AC/Heating Unit is located on the left side of the home and is inaccessible to children due to locked fence.

Meals: Licensee provides breakfast, lunch, dinner and snacks. Licensee participates in the Ventura food program. LPA informed licensee any food brought from the children's homes, the container shall be labeled with the child's name, date and properly stored or refrigerated. Licensee stated there are no children with severe food allergies. Per licensee, the knives and sharp objects are stored on an upper cabinet making them inaccessible to children. Per Licensee, cleaning compounds items are stored underneath the kitchen sink and the laundry room.

Pets/Poison/Firearms/Body of water: LPA asked the licensee if there were any pets, poisons, firearms, weapons, or bodies of water. Per Licensee, there are no pets, poison (e.g. drano, rat poison, etc.), firearms, weapons, but there is a pool at the facility. LPA did not observe pets, poisons, firearms, and weapons. The licensee was informed that if any firearms are purchased, it is required the firearm and ammunition/firing pins are stored separately and locked with a key or combination lock.



Pool/body of water: There is an in-ground pool in the backyard, adjacent to the outdoor play area. LPA observed iron fencing with three gate doors that provides access to the in-ground pool and encloses the pool from the remainder of the backyard. Two gate doors have master key locks. The fence is 60 inches in height. The fence does not obscure the pool from view. The vertical clearance from the ground to the bottom of the enclosure did not exceed two inches. There were no gaps or voids wider than 4 inches. LPA tested the gate to swing away from the pool, self-close and self-latch.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Sara Rajapakse Montolla
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 364844287
VISIT DATE: 09/30/2026
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The pool alarm is installed in the water and meets requirements. Alarm was tested and sound was heard by LPA. LPA informed Licensee that pool alarm must be turned on and in working order during all child care hours. LPA observed a retractable rescue pole with a body hook at a minimum length of 12 feet near the pool. LPA informed Licensee that a rescue pole with a body hook must be readily available for use and must be at a fixed length of 12 feet. Licensee stated that she will purchase a rescue pole with a body hook that is not retractable. LPA observed a daily pool check log documentation.

LPA observed a life ring with a minimum exterior of 17 inches, but it was not approved by the U.S. Coast Guard. Licensee stated she will purchase a life ring that is approved the the U.S. Coast Guard. Licensee shall ensure that there are no climbing aids around the fence that could be used as a handhold or foothold for children to climb. LPA observed a dirt hill near the right-side of the fence that wraps around the pool. Licensee stated that she does not allow children to play on the right side of the playground and that it is off-limits. LPA informed licensee that the pool requirements will remain in place whenever licensed care is provided, and so long as the requirements make the pool inaccessible to children as determined by the licensing department.

Illness and medication: In case of illness, licensee stated that children will be isolated by the entrance den on an adult size couch until parents pick-up the child. Household medications are stored in an off-limits bedroom and inaccessible to children.

Disaster emergency safety: LPA observed the required 2A10BC fire extinguisher located in the kitchen and mounted on the wall. LPA observed the valve on the green area indicating fully charged. LPA did not observe a service tag dated nor purchase receipt within the year. LPA informed licensee the fire extinguisher must be service annually or show purchase receipt within a year. LPA observed a dual smoke alarm/carbon monoxide detector located in the hallway by the bathroom. LPA tested the dual smoke alarm/carbon monoxide and heard the sound, and it is operable. LPA observed the last disaster emergency drill conducted on 09/03/2026 at 4:00pm.

LPA observed licensee American Red Cross Pediatric CPR and First Aid dated 03/01/2025. Licensee has proof of Health and Safety certification, immunization against Pertussis, Measles, and Influenza declination. Licensee has completed the Child Abuse Mandated Reporter training dated 8/21/2025.

LPA observed the postings License, and Pub 394 Notification of Parents Rights. LPA also reviewed licensee’s file, children’s roster and children’s files. LPA observed the files to be complete.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Sara Rajapakse Montolla
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 364844287
VISIT DATE: 09/30/2026
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The following was also discussed with the licensee:

The following items are zero tolerance:
1. Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09.

2. The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

3. Pediatric First Aid and CPR: American Heart Association or American Red Cross or Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR must be present. Certification must be renewed every two years.

4. Licensee was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

5. In the absence of the licensee, a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), Child Abuse Mandated Reporter Certificate.

6. A current roster of enrolled children must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

7. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

8. The fire extinguisher type 2A-10BC or 3A40BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

9. Changes should be reported to the Department as soon as they occur such as, but not limited to closures,
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Sara Rajapakse Montolla
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 364844287
VISIT DATE: 09/30/2026
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additional adults residing, construction, remodeling, telephone number changes and/or if you move from your home.

10. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B).

11. Fire and disaster drills must be performed at least once every six (6) months and documented for review by the Department.

12. Smoking is prohibited in the family childcare home.



13. Children and staff records must be maintained and updated as needed and be available for review by the Department.

14. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children, including those who reside in the home must have proof of immunization.

15. Inspection Authority: All adults living and working in the home shall be made aware of the Department’s right to inspect the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.



16. The facility license number must be on all advertisements, publications, or announcements with the intent of attracting clients.

17. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

18. Liability Insurance was discussed; LPA informed licensee to review Title 22 Regulation 102417(m)(1) for additional information.

19. Dog(s) and/or pets are recommended to be isolated from children in care.

20. Infant walkers, Johnny jumpers, or any other item that falls into this category are not permitted in the facility.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Sara Rajapakse Montolla
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 364844287
VISIT DATE: 09/30/2026
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Licensee Latoya Jackson 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. LPA discussed the safe sleep regulations with licensee Latoya Jackson 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 Latoya Jackson of the importance of checking for and removing any 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 22-02CCP. 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 Latoya Jackson was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. During the exit interview, the Licensee Latoya Jackson, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. 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 [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/inspection-process.

There were no deficiencies cited at this time. Two Technical Violations given. See attached LIC 9101TV. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of the Appeal of Rights was given. LIC 126 Checklist for Family Child Care was provided and reviewed. Exit interview conducted and report was reviewed with licensee Latoya Jackson

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Sara Rajapakse Montolla
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
LIC809 (FAS) - (06/04)
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