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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408726
Report Date: 12/05/2022
Date Signed: 12/05/2022 01:03:11 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/05/2022 01:03 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:JACKSON-MORNING, GINAFACILITY NUMBER:
073408726
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Gina Jackson-MorningTIME COMPLETED:
01:17 PM
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On Monday, December 5, 2022 10:58 AM, Licensing Program Analyst (LPA) Caroline Colson met with Gina Jackson-Morning, for an unannounced change in capacity inspection. Fire Clearance was received. There are no children present. The home was toured to conduct a health and safety inspection. Hours of Operation are Monday - Friday from 5:30 AM - 5:30 PM.

Indoor Space: The home is a two story home. The home consists of a living room with eating area, family room, kitchen, one downstairs bedroom, five upstairs bedrooms, master bathroom, two downstairs bathrooms, one additional upstairs bathroom, storage room, hallway closet, converted garage, detached game room which is located in the back yard and fenced back yard. The home has a 3A40BC fire extinguisher, a working smoke detector and a working carbon monoxide detector. Licensee states there are no firearms in the home. The isolation area is the living room. Her infant CPR and First Aid certificates are current and expire on April 2024. Mandated Reporter Training certificate is current and expires on April 12, 2024. She has a first aid kit. There are no pets.

Outdoor Play Space: Licensee will use her fenced back yard for outdoor play.

Off Limit Areas: The off limit areas are all upstairs bedrooms, upstairs bathroom, one downstairs bathroom, one downstairs bedroom, master bathroom, storage room and hallway closet.


Please LIC 809 C for Additional Information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JACKSON-MORNING, GINA
FACILITY NUMBER: 073408726
VISIT DATE: 12/05/2022
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CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov



ยท Licensees may register to receive child care updates: www.myccl.ca.gov

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 ADA, available at: http://www.ada.gov/childquanda.htm

Family Child Care Homes

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.


Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JACKSON-MORNING, GINA
FACILITY NUMBER: 073408726
VISIT DATE: 12/05/2022
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Safe Sleep

LPA discussed the safe sleep regulations with Gina Jackson-Morning and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Gina Jackson-Morning 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.

Licensee needs to purchase an appropriate heating source for the converted garage where the children will be located.

Notice of Site Visit

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

Exit Interview

Exit interview conducted and report was reviewed with the licensee, Gina Jackson-Morning.

Original Signatures are on file.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC809 (FAS) - (06/04)
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