073409575-8-23-2024-02-CC-ILOA-D8EPJF-20240823112127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409575
Report Date: 08/23/2024
Date Signed: 08/23/2024 11:21:36 AM

Document Has Been Signed on 08/23/2024 11:21 AM - 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	JACKSON, KAUSHA		FACILITY NUMBER:	073409575
ADMINISTRATOR/ DIRECTOR:	KAUSHA JACKSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 275-9883
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	08/23/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Jackson Kausha		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 23, 2024 at 9:30am, Licensing Program Analyst (LPA) Indira Loza arrived announced to a change of location inspection and met with applicant Kausha Jackson. Residing in the home is the applicant, her finger print cleared adult daughters, and her two minor grandchildren. The home was toured to conduct a health and safety inspection. The applicant plans to operate between the hours of 6:45am -5:45pm, Monday through Friday. The home is a two story house that consists of five bedrooms, three bathrooms, a two car garage, and a fully fenced in large backyard. On-limit-areas are the: Living Room (located next to the entrance), Family Room (located next to the kitchen), the downstairs bedroom (which will be the main daycare area), and the downstairs bathroom. Off-limit-areas are: The entire upstairs, the garage, backyard, the dining room (will only be used for the children to walk through from the entrance to the family room). All off limit areas will be made inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be in the living room next to the main entrance The home is neat and clean with heating and ventilation for safety and comfort of the children. The entrance to the child care will be the front door. LPA observed age appropriate toys that appear to be safe, clean and in good repair. There are no bodies of water or pools accessible to children during today’s inspection. LPA did not observe any hazardous materials or toxins, or medications accessible to children during today’s inspection. Per Applicant, there are no firearms or pets in the home. During today's inspection LPA observed the following precautions the plugs have covers and the stairs has a safety gate to prevent access. There is a fully charged 3A40BC fire extinguisher in the closet across from the downstairs bathroom, a

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JACKSON, KAUSHA	FACILITY NUMBER: 073409575
	VISIT DATE: 08/23/2024

NARRATIVE

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working smoke detector and carbon monoxide detector located in the hallway next to the daycare room. There is a fireplace in the family room that has glass doors preventing access to the children. The applicant stated that she will not be using the fireplace. The applicant has a current CPR certificate which expires on February 2026 and a current mandated reporter certificate which expires February 2025. The applicant is in compliance with the immunization laws which pertains to all childcare providers.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 informed the applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The applicant was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com. CPR/First Aid Training is also to be renewed every two years

Baby bouncers & drop-down cribs are not allowed at the day-care facility. A children's roster must be properly maintained and fire/disaster drill every six months must be documented.

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.

The applicant has obtained a signed Property Owner/Landlord Consent form (LIC9149) signed by the landlord and provided a proof of control of the property.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JACKSON, KAUSHA	FACILITY NUMBER: 073409575
	VISIT DATE: 08/23/2024

NARRATIVE

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LPA verified that the applicant, and all other adults living in the home, have a criminal record clearance and are associated to the license. 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, 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.

On August 23, 2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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. 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.

On August 9, 2024, Inspector Dante Wiley from the CIty of Richmond Fire Department approved a Fire Clearance for 14 children. The Fire clearance was received in the Oakland Regional Office on August 19, 2024 via Fax.

The License for a Large Family Childcare home is being granted, effective today August 23, 2024.

Exit Interview conducted. Report reviewed with Licensee Kausha Jackson. A copy of the report was also provided to Licensee Kausha Jackson.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

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