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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417591
Report Date: 04/25/2022
Date Signed: 04/25/2022 02:14:16 PM


Document Has Been Signed on 04/25/2022 02:14 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
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: DATE:
04/25/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Juanita Dockery, LicenseeTIME COMPLETED:
01:30 PM
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On Thursday, April 25 2022, Licensing Program Analyst (LPA) Alicia Mooberry and Licensing Program Manager (LPM) Valarie Cook conducted a virtual Informal Office meeting with Licensee, Juanita Dockery.

The purpose of the meeting was to discuss the above facility's history of non-compliance and to provided resources to maintain the facility in compliance with California Title 22 regulations.

Technical Support Program (TSP) services were explained to the Licensee and a referral will be made.

Exit interview conducted with Juanita Dockery, Licensee. A copy of this report will be emailed to the Licensee. Licensee will sign this report and return to the Department.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
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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