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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020110
Report Date: 11/17/2025
Date Signed: 11/17/2025 03:23:25 PM

Document Has Been Signed on 11/17/2025 03:23 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:JACKSON FAMILY CHILD CAREFACILITY NUMBER:
198020110
ADMINISTRATOR/
DIRECTOR:		NATALIE JACKSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 676-3770
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
11/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Licensee, Natalie JacksonTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On November 17, 2025 at 1:30 pm Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced annual inspection at the above facility. LPA was greeted by Licensee, Natalie Jackson who guided LPA on a tour of the facility. Licensee's assistant who obtains criminal record clearance was also present during the inspection. Per licensee there are 14 children enrolled, and LPA observed 9 children in care during the inspection. Hours of operation are Monday - Friday from 6:00 am – 6:00 pm.

Family members residing in the home are 1 adult who obtains criminal record clearance, 1 adult who is pending criminal record clearance and 1 minor child. This is a single-story home that consists of 4 bedrooms, 2 bathrooms, den (playroom), living room, kitchen, side yard (completely fenced), front yard and detached garage.

Off limit areas are living room, kitchen, 1 bathroom, and 3 bedrooms. All areas identified on the facility sketch were inspected.

Areas accessible to children in care are the Bedroom 1 (back room near den), 1 bathroom in bedroom 1, den, and side yard (fenced)

At 1:45 pm the licensee guided LPA on a tour of the facility. Per licensee, parents enter through the side entrance driveway which leads them to the side door of the home. Upon entrance of the side door, LPA inspected the den area and observed 3 napping children and multiple age appropriate toys for children in care. LPA then inspected bedroom 1 which is a back room next to the den area. In bedroom 1, LPA observed multiple age appropriate toys for children in care. LPA also observed all required posting to be mounted on the wall in bedroom 1 along side the door leading to the side yard.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2025
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 6
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.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 198020110
VISIT DATE: 11/17/2025
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The bathroom located in bedroom 1 that the children have access to was then inspected. LPA did not observe any hazards that can pose a danger to children in care in the bathroom. Napping equipment in the form of mats and pack n plays for children in care were observed. Per licensee all children’s bedding is washed at the facility weekly. LPA then inspected the side yard and observed multiple age-appropriate toys for children in care. All areas were observed to be clean, orderly, comfortable, and well ventilated.

There are first aid supplies available. Per licensee, the facility provides meals for children in care. LPA reminded licensee that food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated.

If a child becomes ill, the child is isolated in a corner in bedroom 1 while the parents are called. A mat is available if needed.

Licensee's poisons, detergent, cleaning compounds, medications and other items which could pose a danger to child are stored where they are inaccessible to children.

LPA observed a smoke/carbon monoxide detector near the den area. However, LPA did not test smoke/carbon monoxide detector as children were napping. LPA observed a 2A-10BC fire extinguisher in the kitchen area. The valve on the fire extinguisher pointed to the fully charged green section and serviced on 11/08/2025. There is a working telephone on site. Per Title 22 Emergency Disaster Drill must be conducted and documented at least every 6 months. LPA observed the last emergency disaster drill conducted and documented on 11/05/2025.

Per the licensee, there are no weapons, pets or bodies of water on the premises. Licensee obtains current Pediatric First Aid and CPR certification which expires on 10/05/2026

LPA conducted a children file review and deemed it complete. LPA conducted staff file review and deemed it complete. LPA consulted with licensee about licensee’s adult son who lives in the home and is currently still in high school about obtaining criminal record clearance. LPA did observe that this individual is in process in obtaining clearance through Guardian since 07/2025. LPA has instructed licensee to follow up with guardian to obtain any information about his clearance.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 198020110
VISIT DATE: 11/17/2025
NARRATIVE
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Licensee has completed mandated reporter training which expires 08/23/2027. All childcare employees must complete mandated reporter training within 30 days of hire and renew training every two years at www.mandatedreporterca.com

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) and Earthquake preparedness Checklist.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 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 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 licensee [or facility representative] 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.

Licensee 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.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JACKSON FAMILY CHILD CARE
FACILITY NUMBER: 198020110
VISIT DATE: 11/17/2025
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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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today, November 17, 2025.

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

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

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

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
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