197417591-2-7-2025-54-CC-AMOY-DDNM9Y-20250207082530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417591
Report Date: 02/06/2025
Date Signed: 02/07/2025 08:26:07 AM

Document Has Been Signed on 02/07/2025 08:26 AM - 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	DOCKERY FAMILY CHILD CARE		FACILITY NUMBER:	197417591
ADMINISTRATOR/ DIRECTOR:	DOCKERY JUANITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 271-7797
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 6	DATE:	02/06/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Juanita Dockery, Licensee		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

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On February 6, 2025 Licensing Program Analysts (LPA) Alicia Mooberry, conducted an unannounced Required annual inspection to the above facility. LPA met with licensee, Juanita Dockery, who guided analyst on a tour of the facility. Also present during today’s inspection is licensee’s Assistants Verna Patnett and Mia Hawthorne. There were 6 children present during this inspection. Per licensee, operating hours are Monday-Friday 6:00am-6:30pm. Individuals currently live in the home were discussed and noted.

The facility is the rear unit in a 3 unit lot. This is a one story, 1-Bedroom, 2-Bathroom home. Per Licensee the following areas are used for day-care: Living room, bedroom, restroom, kitchen, back yard and, small room used for activities connected to the garage.

Off limit areas include: Detached garage.

All areas identified on the facility sketch that children use were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating.

Smoke and carbon monoxide detectors in the hallway and kitchen were tested and are operable. Fire extinguisher indicated fully charged and has no service tag. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone/LAN line. The home is observed to be clean and orderly. There are toys and other age-appropriate material available. LPA observed that cleaning compounds are in kitchen in locked cabinet inaccessible to children in care. The bathrooms that children use is in the hallway and in the laundry room in backyard and observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

Per Licensee there are no firearms or weapons stored in the home.
Isolation area for sick children waiting to be picked up is in the living room, supervised and away from the other children. --- Page 1

Denise Gibbs	TELEPHONE: (323) 981-3350
Alicia Mooberry	TELEPHONE: (323) 981-3350
	DATE: 02/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DOCKERY FAMILY CHILD CARE	FACILITY NUMBER: 197417591
	VISIT DATE: 02/06/2025

NARRATIVE

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Licensee has no infants currently in care. LPA discussed the safe sleep regulations with licensee [or facility representative] 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 of the importance of checking for 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.

The back yard enclosed patio is used for outdoor play. The area was observed to be safe with toys and equipment. The licensee uses a a portion of the garage that has been converted as a playroom. LPA advised licensee to not used this room for sleeping/napping of children in care. The facility does not have a pool or similar bodies of water. LPA observed no pets in the home

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)

Staff records were reviewed 2 out of 2 staff were missing current Pediatric First Aid and CPR certification, LIC-501: Personnel Record, Proof of immunizations against measles, pertussis, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

LPA observed that licensee has current Pediatric CPR and 1st Aid

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/

-------------------Page 2 – Report Continues

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DOCKERY FAMILY CHILD CARE	FACILITY NUMBER: 197417591
	VISIT DATE: 02/06/2025

NARRATIVE

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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.

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

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with Title 22 Regulations.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the RSO search in Megan’s Law Website.

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

Exit interview conducted and report was reviewed with the licensee Juanita Dockery. Appeal Rights were reviewed.

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/07/2025 08:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102416.1(a)(6)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that 2 out of 2 staff present did not have a current Pediatric CPR/1st Aid certificate which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/20/2025
	Plan of Correction
1 2 3 4	Per licensee, proof of completion of training on Pediatric CPR/1st Aid for Staff 1 and 2 will be sent to LPA by POC due date.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that 2 out of 2 staff present did not have record of immunizations for MMR and TDAP or TB clearance which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/20/2025
	Plan of Correction
1 2 3 4	Per licensee, proof of immunizations against Measles, pertussis and TB clearacne for Staff 1 and 2 will be sent to LPA by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Denise Gibbs	TELEPHONE: (323) 981-3350
Alicia Mooberry	TELEPHONE: (323) 981-3350
	DATE: 02/06/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 02/07/2025 08:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102418(a)

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that child #1 doesn not have proof of immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/27/2025
	Plan of Correction
1 2 3 4	Per licensse, proof of immunization will be sent to LPA by POC due date

Type B

Section Cited

CCR

102417(g)(1)

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (1) Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in that the fire extinguisher has not been serviced in the last 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/20/2025
	Plan of Correction
1 2 3 4	Per licensee, a fire extinguisher will be purchased or serviced, a purchase receipt or service receipt will be sent to LPA by POC due date

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Denise Gibbs	TELEPHONE: (323) 981-3350
Alicia Mooberry	TELEPHONE: (323) 981-3350
	DATE: 02/06/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

LIC809 (FAS) - (06/04)

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