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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411223
Report Date: 01/14/2020
Date Signed: 01/14/2020 12:23:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:HICKS-DORRIS FAMILY CHILD CAREFACILITY NUMBER:
197411223
ADMINISTRATOR:HICKS-DORRIS, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 272-1488
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 2DATE:
01/14/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Linda Dorris Hicks TIME COMPLETED:
12:36 PM
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Licensing Program Analyst (LPA) Victoria Hunt met with Linda Hicks-Dorris, licensee, who guided analyst on a tour of the facility for a annual random inspection. During the time of this inspection licensee had two children in care; the children were observed to be napping on mats during the time of this inspection. Residing in the home includes: adult (licensee) and 3 other adults.

Home was inspected as follows: Family room, kitchen and dining room, living room, downstairs bedroom, laundry room, and attached garage.

This is a two story 5 bedroom, 3 bathroom home with kitchen/dining room, living room, family room, laundry room, and an attached garage. The garage is used for storage only and no child care activities are conducted in the garage.

Main care is conducted in all areas downstairs. LPA inspected the facility in accordance to the facility sketch. Main care is conducted in the playroom which is the designated (living room and family room). LPA observed age appropriate toys and furniture for the children to play with. There are cubbies in which the children can store their belongings. Several cabinets that were observed to have games, books and toys stored on the shelves. There is educational/learning material posted on the walls and the floor of the facility. LPA observed napping mats in the playroom. The napping equipment is in good repair and sanitary condition.
There is a bedroom that is located downstairs in which the child also play in. It was observed to additional play toys and a small bouncer.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: HICKS-DORRIS FAMILY CHILD CARE
FACILITY NUMBER: 197411223
VISIT DATE: 01/14/2020
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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds. Detergents/cleaning compounds are stored in the pantry. LPA observed a child safety knob on the pantry door.

LPA inspected the kitchen to ensure hazardous and dangerous items were inaccessible to children. All cabinets in the kitchen were inspected and are free of hazardous and dangerous items. Licensee keeps knives and other sharp objects such as (scissors)in the cabinets that are inaccessible to children. All cleaning compounds/detergents are stored so that they are inaccessible to children. All cleaning compounds are stored in the kitchen which are locked by child proof latches.

Children utilize a bathroom that located in the hallway. The bathroom was observed to be free and clear of hazardous items. The bathroom was observed to have working toilet, sink, and an ample supply of paper towels and soap accessible for the children to use. Lower cabinets were observed to have diapers and additional toiletry items. The bathroom was clean, sanitized and in good repair.

Children do not have access to the backyard. The backyard is off limits. The backyard is dirt landscaping and the backyard is completely surrounded by fencing.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: HICKS-DORRIS FAMILY CHILD CARE
FACILITY NUMBER: 197411223
VISIT DATE: 01/14/2020
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This facility has a fire extinguisher 2A10BC meets fire marshal standards and was operational during visit. The home has a working telephone service available. Per licensee, disaster/fire drills are conducted every six months. LPA observed disaster/fire drill log as current.

This home was clean, orderly and comfortable for children in care. This facility has a first aid kit on premises. LPA observed that licensee has a valid Pediatric CPR and First Aid card that expires on 08/2021. A copy of the of the Pediatric CPR and First Aid was obtained for the file. This facility has a current roster. Licensee has completed mandated reporter training and has the required immunization for pertussis and measles.

Per licensee there are no weapons or firearms on the premise. There are no pools or bodies of water on premies at this facility.

Areas off limit include: all bedrooms and bathrooms that are located upstairs. There is a security gate that on the staircase that prevents children fro accessing the upstairs bedrooms. The backyard, laundry room, and attached garage.

Licensee is not providing any medical services to children. 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 the ADA, available at: http://www.ada.gov/childqanda.htm

The following was discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the home. Individuals within one month of their 18th birthday must be fingerprinted immediately or at least within 30 days or less of turning 18.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: HICKS-DORRIS FAMILY CHILD CARE
FACILITY NUMBER: 197411223
VISIT DATE: 01/14/2020
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There shall be no smoking, no infant walkers, johnny jumpers, exersaucers and any other item that falls into that category. Also discussed were earthquake, fire & disaster drills shall be documented at least once every six months. Posting requirements were discussed such as the posting of the Parent’s Rights poster in a visible location for the children’s authorized representatives. Children records requirements, mandated child abuse and injury/ death reporting, background check clearance transfer requirements, SIDS, Infants Safe Sleep on Back, and Never Shake A Baby were all discussed. Licensee agrees children shall be positioned for sleep on their back.

**Licensee informed to review updates/regulations for 2016/2017 on the department website: www.ccld.ca.gov ; AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018; AB 1387 - and AB 2236 process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles, and TB clearance, beginning September 1, 2016; AB 2231 Effective July 1, 2017 - Civil Penalty Amount changes. Licensee states that she is receiving Quarterly PINS from CCLD for latest CCLD updates.

This facility was in compliance with Title 22 Regulations. No citations were issued during this inspection. A copy of this report was read and discussed with licensee. Notice of Site Visit was left at the facility.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
LIC809 (FAS) - (06/04)
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