073404422-4-16-2024-02-CC-BCRS-D4DQAL-20240416120003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073404422
Report Date: 04/16/2024
Date Signed: 04/16/2024 12:00:22 PM

Document Has Been Signed on 04/16/2024 12:00 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	JACKSON, KAUSHA		FACILITY NUMBER:	073404422
ADMINISTRATOR/ DIRECTOR:	JACKSON, KAUSHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 215-5392
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94804
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 7	DATE:	04/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Kausha Jackson		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

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On 4/16/2024 at 9AM, Licensing Program Analyst (LPA) Brittany Crass arrived at the home for an unannounced annual/random inspection. LPA met with licensee Kausha Jackson. There was 1 infant, and 6 preschool aged children in care during the inspection. An assistant plus an additional school aged child arrived at 10:20AM. This family childcare home operates Monday - Friday 7AM-5:30PM. There are two dogs which reside in off-limit areas of the home. LPA verified that the licensee's phone number and email address on file are correct.

LPA toured the first floor of the home with the licensee, to conduct a health and safety inspection. The home is a two story home. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children in care. The on-limit areas include the living room, downstairs bedroom, downstairs bathroom, and the family room. The off-limits areas include the dining room, kitchen, entire upstairs, and the garage. The front and back yards are not used for outdoor play and are off-limit areas. The off-limit areas are made inaccessible by closed and/or locked doors, gates, and visual supervision. The licensee walks children to a nearby park for outdoor play. The family room is used for isolation of sick children, away from other children in care. The fireplace in the living room is blocked to prevent access by children. LPA observed an ample supply of age-appropriate toys, equipment and activities available for children indoors and observed that they are in good condition. The licensee stated that there are no firearms on the premises.

The home is equipped with fully charged 3A40BC fire extinguisher, a working carbon monoxide detector, working smoke detector, and a working telephone. Licensee has proof of current CPR/First aid certificates, which expire on 2/16/2026, and a Mandated Reporter Training certificate which expires on 2/1/2025. The last documented fire drill was conducted on 4/2/2024. LPA observed all of the required forms posted. LPA reviewed children's files, staff files, and obtained a copy of the current roster.

(Report continued, See 809-C).

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JACKSON, KAUSHA	FACILITY NUMBER: 073404422
	VISIT DATE: 04/16/2024

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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.

LPA discussed the safe sleep regulations with the 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.

LPA reminded the licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. LPA provided the main office number for the Oakland Regional Child Care office (510) 622-2602 for the licensees to call and report injuries or unusual incidents and reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The licensees were encouraged to periodically review regulations, guidelines and Provider Information Notices (PINs) on the website www.ccld.ca.gov.

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 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.

(Report continued, See 809-C).

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JACKSON, KAUSHA	FACILITY NUMBER: 073404422
	VISIT DATE: 04/16/2024

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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.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

See 809-D for deficiencies cited during todays visit.

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

Appeal rights provided and discussed.

Exit interview conducted and report was reviewed with the licensee Kausha Jackson.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/16/2024 12:00 PM - It Cannot Be Edited

Created By: Brittany Crass On 04/16/2024 at 11:18 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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JACKSON, KAUSHA	FACILITY NUMBER: 073404422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/16/2024

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by having an assistant without proof of Mandated Reporter Training certificate on file, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/23/2024
	Plan of Correction
1 2 3 4	By 4/23/24, the licensee will have her assistant complete the Mandated Reporter Training, and will email LPA a copy of the certificate.

Type B

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above by having one infant, and six preschoolers present without an assistant, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/17/2024
	Plan of Correction
1 2 3 4	By 4/17/2024, the licensee will email LPA a statement on how she will remain within capacity requirements when an assistant is not present.

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:

Mayla Mendoza

LICENSING EVALUATOR NAME:

Brittany Crass

LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC809 (FAS) - (06/04)

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