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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417591
Report Date: 07/22/2021
Date Signed: 07/22/2021 04:32:33 PM

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: 13DATE:
07/22/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Juantita Dockery, Licensee TIME COMPLETED:
04:31 PM
NARRATIVE
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An unannounced Plan of Correction (POC) inspection was conducted on this date by Licensing Program Analyst (LPA) Alicia Mooberry in order to verify that citations issued on 07/08/21 have been corrected. Upon arrival, LPA met with Juanita Dockery, Licensee, who guided LPA on a tour of the home. There were 13 children present, including 1 infant. Licensee was advised that the facility if over the license capacity during this inspection. This poses an immediate risk to the health and safety of children in care. Licensee stated that Child #8 was previously enrolled and parent needed emergency care on this day only. Children were picked up and licensee was in compliance.

During today's inspection, the following deficiencies cited on 01/02/18 were verified to have been corrected:
1. Licensee has completed children's files
2. Licensee has purchased a new fire extinguisher.
3.Licensee has completed the Mandated Reporter Training
4. Licensee has a safety lock on the cabinet under the kitchen sink.

Three Letters of the above cleared deficiencies have been provided to licensee Juanita Dockery.

Deficiencies were cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes. See 809D

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

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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 3
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: 07/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2021
Section Cited

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
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LPA observed that there were 13 children present in care during today's inspection exceeding the license capacity of 12. Per licensee, child #8 was in need of emergency care to this day only.
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: 07/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 07/22/2021
NARRATIVE
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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.

An exit interview has been conducted with Juanita Dockery, Licensee. Appeal Right were provided and discussed.



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

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3