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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609726
Report Date: 04/28/2023
Date Signed: 05/01/2023 10:53:13 AM

Document Has Been Signed on 05/01/2023 10:53 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:JAMISON FAMILY DAY CAREFACILITY NUMBER:
191609726
ADMINISTRATOR:JAMISON, JACQUELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 658-0134
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
04/28/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Jacquelyn JamisonTIME COMPLETED:
06:30 PM
NARRATIVE
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On 4/28/23 at 4PM, Licensing Program Analyst (LPA) V. Wheatley conducted a case management inspection and was informed that a serious incident occurred that was not reported to the Department. LPA met with licensee Jacquelyn Jamison who was supervising 14 children today. LPA observed 9 children upon arrival and the additional 5 children were picked up at a nearby elementary school. The licensee's assistant was present with the 14 children in care.

In addition, LPA Wheatley conducted children's interviews and was informed that the licensee is placing the children into a corner for time out. See LIC 809D.

Exit interview. A copy of the report will be provided to the licensee.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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Document Has Been Signed on 05/01/2023 10:53 AM - It Cannot Be Edited


Created By: Veronica Wheatley On 04/28/2023 at 05:37 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JAMISON FAMILY DAY CARE

FACILITY NUMBER: 191609726

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2023
Section Cited
CCR
102423(a)(4)

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102423(a)(4) Personal Rights- Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature....
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Licensee will ensure that children's personal rights are protected at all times. License will attend FCCH Orientation class and submit proof of attendance. Licensee will watch the Department videos for personal rights. (childcarevideos.org) and submit what was learned. Licensee will submit plan of correction to the Department by May 1, 2023
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LPA interviewed children who stated that the licensee places them in the corner on time out. LPA interviewed the licensee who admitted that she places the children in time out standing in the day care room and that she did not know this was a violation.
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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:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


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Document Has Been Signed on 05/01/2023 10:53 AM - It Cannot Be Edited


Created By: Veronica Wheatley On 04/28/2023 at 05:43 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JAMISON FAMILY DAY CARE

FACILITY NUMBER: 191609726

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2023
Section Cited
CCR
102416.2(b)

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102416.2(b)-Reporting Requirements-The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.
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Licensee shall submit a Unusual Incident Report LIC 624B and wrirtten report to the department by 5/5/23 regarding an incident that occurred with two children.
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Licensee failed to report an unsual incident to the Department that occurred between two day care children. This is required according to Title 22 Regulatiosn and is a potential risk to the children in care.
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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:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


LIC809 (FAS) - (06/04)
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