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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417591
Report Date: 07/08/2021
Date Signed: 07/08/2021 02:33:09 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DOCKERY FAMILY CHILD CAREFACILITY NUMBER:
197417591
ADMINISTRATOR:DOCKERY JUANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 296-0489
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:12CENSUS: 12DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Juanita Dockey, LicenseeTIME COMPLETED:
02:45 PM
NARRATIVE
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On July 8, 2021 Licensing Program Analysts (LPA) Alicia Mooberry, conducted an unannounced Required annual inspection to the above facility. At 9:20 LPA met with licensee, Juanita Dockery, who guided analysts on a tour of the facility. Also present during today’s inspection is licensee’s Assistant Verna Patnett. There were 12 children present during this inspection (including a 13-month old infant).

The facility is a one story, 1-Bedroom, 1-Bathroom home located in the rear of a triplex. Per Licensee the following areas are used for day-care: Living room, bedroom, restroom and back yard. Per Licensee, Off limit areas include: kitchen, laundry room, detached garage and front yard area. Per licensee, operating hours are Monday-Sunday 24 hours. Although the kitchen is "off limits" the children walk through kitchen to access the back yard. Licensee stated children are supervised at all times.

Individuals currently live in the home were discussed and noted.

All areas identified on the facility sketch that children use were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. The following was observed during this visit.



PHYSICAL PLANT
· Detergent, cleaning compounds, medications are kept in cabinets under the sink in bathroom and kitchen at 9:31am LPA observed Raid, Comet and other item in the unlocked cabinet under the kitchen sink. This poses an immediate risk to the health and safety of children in care. Licensee was reminded that all poisons and harmful chemicals must be locked an inaccessible to children in care.
  • The back yard/ enclosed patio is used for outdoor play. The area was observed to be safe with toys and equipment (With the exception of the trampoline)
  • There is a small room with bathroom used for activities connected to the garage. LPA advised licensee to not used this room for sleeping/napping of children in care.
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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DOCKERY FAMILY CHILD CARE
FACILITY NUMBER: 197417591
VISIT DATE: 07/08/2021
NARRATIVE
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· Home has air conditioning unit. The heater in the bathroom that has been disconnected. Per licensee, plug in heater is used when it's cold.
· The required 2A 10BC fire extinguisher was missing the service tag and could not be located. Smoke and carbon monoxide detectors were tested, and are in operable condition.
· Licensee was reminded to keep the home is kept clean and orderly.
· LPA observed trampoline in the backyard accessible to children in care. The safety net and spring cover were torn exposing the springs (photo taken) this poses an immediate risk to the health and safety of children in care.
· The home provides age appropriate toys and materials.

CARE AND SUPERVISION
· When temporary absent from home, the licensee arranges for a substitute adult to care and supervise children in their absence.
· The licensee is operating within the license capacity limitations. The facility is currently licensed for 12 children. Licensee was reminded that the capacity specified on the license shall be the maximum number of children for whom care can be provided. For a large FCCH, the maximum number of children for whom care shall be provided when there is an assistant provider in the home, (including children under age 10 who live in the home) shall be 12 children, if no more than 4 of whom may be infants.
· Each child has a safe, healthful, and comfortable accommodations, furnishings, and equipment.

ADMINISTRATION AND RECORD REVIEW
· Licensee does not have a current roster of the children enrolled.
· Children’s records of children present were reviewed for completeness and found that all 12 children were missing LIC 700. Licensee is missing 8 of 12 children's files Child 1, 5, 6, 7, 8, 10, 11, 12.
o Children’s files were incomplete or missing
· All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. The last recorded fire/disaster drill was 5/20/20.
· Licensee has incomplete documents immunization records and updates in children’s records.
· Notification of Parents’ Rights receipt on file for each children in care - missing for 8 of 12 children's files Child 1, 5, 6, 7, 8, 10, 11, 12
· All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.
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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DOCKERY FAMILY CHILD CARE
FACILITY NUMBER: 197417591
VISIT DATE: 07/08/2021
NARRATIVE
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· The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. Completed on 9/21/20
· Licensee and staff are missing Mandated Reporter Certificate. LPA discussed
AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com.

NO ZERO TOLERANCE deficiencies cited during this visit. Zero Tolerance includes:
· Absence of Supervision.
· Accessible Bodies of Water. No body of water, pool or spa in the home.
· Accessible Firearms, Ammunition or Both. No firearms or weapons in the home.
· Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g)(2).
· The Presence of an Excluded Individual. No excluded individuals.
· Children are not left in parked vehicles.

The following items were also discussed with licensee during this visit.
· Dog(s) and or pets are recommended to be isolated from children in care. No pets at this time
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
· There are first aid supplies available.
· No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
· LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS)
Safe Sleeping regulations were discussed.
  • LPA provided PIN 20-24-CCP, LIC 9227 and consulted with licensee regarding the required Infant sleep log - for infants 12 months and under. Per licensee, there are no infants 12 months or younger attending.
Incidental medical services are not currently being provided. Licensee was advised that she must contact the Dept 30 days prior to enrolling a child with IMS needs.
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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DOCKERY FAMILY CHILD CARE
FACILITY NUMBER: 197417591
VISIT DATE: 07/08/2021
NARRATIVE
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LPA reviewed and issued the LIC 9232 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal record transfer requirements, criminal record and child abuse clearances were also discussed during this visit.
Licensee was reminded it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov.

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541


Email Address: childcareadvocatesprogram@dss.ca.gov
Deficiencies were cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes. See 809D

Whenever a type A is cited: “Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.” The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.
Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Juanita Dockey, Licensee. Appeal rights provided and explained.

End of report
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DOCKERY FAMILY CHILD CARE
FACILITY NUMBER: 197417591
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2021
Section Cited

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The home shall be free from defects or conditions which might endanger a child. Poisons… and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
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LPA observed Raid, Comet and other chemicals in an unlocked cabinet under the kitchen sink. (photo taken).

This poses an immediate risk to the health and safety of children in care.
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Type A
07/08/2021
Section Cited

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102417 (d) The home shall provide safe toys, play equipment and materials.


This requirement is not met as evidenced by:
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LPA observed a trampoline in the backyard accessible to children in care. The safety net and spring cover were torn exposing the springs (photo taken).

This poses an immediate risk to the health and safety of 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DOCKERY FAMILY CHILD CARE
FACILITY NUMBER: 197417591
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2021
Section Cited

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The licensee shall maintain, in each child's record, a copy of the emergency information card that contains all of the information specified by regulation.

This requirement is not met as evidenced by:
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Per LPA file review and licensee disclosure. 12 of the 12 children present in the childcare home were MISSING the LIC 700 Emergency Information form.

This poses a potential risk to the health and safety of children in care
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Type B
07/22/2021
Section Cited

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Prior to admission to a family day care home, children shall be immunized against diseases...The licensee shall document each child's immunizations... and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
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Per file review and licensee admission. 4 out of 12 children present during inspection are missing children's file including proof of immunization.

This poses a potential risk to the health and safety of 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DOCKERY FAMILY CHILD CARE
FACILITY NUMBER: 197417591
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2021
Section Cited

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...a licensed child day care provider...or employee of a licensed child day care facility shall complete the mandated reporter training... and shall complete renewal mandated reporter training every two years following the date...completed the initial
mandated reporter training.
This requirement is not met as evidenced by:
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Per file review and licensee admission, licensee and staff have not completed the Mandated Reporter Training. LPA did not observe the Certificate in the staff or licensee's files.
This poses a potential risk to the health and safety of children in care.
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Type B
07/15/2021
Section Cited

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102417 (g)(1)...The home shall contain a fire extinguisher... meet standards established by the State Fire Marshal. This requirement is not met as evidenced by
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LPA observed the required 2A10BC fire extinguisher in the kitchen, missing the service tag.

This poses a potential risk ti the health and safety of 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2021
LIC809 (FAS) - (06/04)
Page: 7 of 7