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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400675
Report Date: 11/01/2022
Date Signed: 11/01/2022 11:19:47 AM

Document Has Been Signed on 11/01/2022 11:19 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DICKERSON FAMILY CHILD CAREFACILITY NUMBER:
198400675
ADMINISTRATOR:DICKERSON, ANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 200-8647
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Anita Dickerson, LicenseeTIME COMPLETED:
11:40 AM
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Licensing Program Analysts (LPA) Susann Sanchez conducted an announced prelicensing inspection for an change in location at the above facility on 11/01/2022 at 09:45 AM. LPA met with Anita Dickerson, Licensee who guided analysts on a tour of the facility. Also present was Licensee 2 adult children and husband. Licensee received a granted fire clearance on 10/28/22 by Fire Inspector E. Martinez. Licensee is also licensed 353 E. 169th St., Carson CA 90746, facility number 198018981 which is placed on Inactive Status due to physical plant issues. Until physical plant issues are resolved, Licensee will continue services at the address above which is estimated to be about 6 months.

Per Licensee, hours of operation will be Monday through Sunday, 6:30am to 8:00pm and does not to exceed 24 hour care at one time. Licensee states that she will care for children Infants -14 years of age.

This is a one story home which consists of 5 bedrooms, 3 bathroom, kitchen, den, family room, living room, garage, front and back yard. The home was inspected for safety, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Areas used by children include: Living room, den, family, kitchen, bathroom located hallway, one bedroom isolation area only, front and backyard. Areas off limits include: All of other bedrooms, 2 bathrooms, and garage.


The off limit areas are inaccessible by door knobs locks and latches. Knives and other sharp utensils are located in high shelf in the kitchen. Cleaning products were locked with safety latches under the sink in kitchen.

The home is clean and orderly, there are outlet covers throughout the home. Smoke detectors and carbon monoxide detector were observed, tested and found to be operable.

Licensee has completed the required health and safety training, the Pediatric First Aid and CPR Exp. 5/2023 Licensee has proof of immunization against pertussis and measles, influenza in file. Proof of Mandated Reporter Training was also submitted and expires on 01/19/24

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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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: DICKERSON FAMILY CHILD CARE
FACILITY NUMBER: 198400675
VISIT DATE: 11/01/2022
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LPA observed the required fire extinguisher that is fully charged and purchase on 09/09/22. Licensee was informed to have the fire extinguisher serviced yearly. Per Licensee, there are no weapons or firearms in the facility, none were observed by LPA. There is portable air conditioning in the home and central heating. There are no bodies of water on the premises.

Licensee will use the backyard and front yard for outdoor play. Licensee also stated that she will take children on walks around the neighborhood. Per Licensee children will never be left alone when they are outside.

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.

Licensee does not have any infants enrolled. If Licensee gets infants in the future, LPA advised the Licensee to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. LPA provided the Licensee with a copy of Provider Information Notice (PIN) 20-24-CCP and the Individual Infant Sleeping Plan (LIC 9227) to the Licensee.
LPA discussed the safe sleep regulations with applicant 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 advised Licensee to ensure they are following the guidance from the local health authorities in order to prevent and reduce the transmission of diseases.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platform.



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: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
Page: 3 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: DICKERSON FAMILY CHILD CARE
FACILITY NUMBER: 198400675
VISIT DATE: 11/01/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

There are no physical corrections needed during today's visit. LPA will submit application to the Department for final review. Exit interview conducted and report was reviewed with the Licensee Dickerson.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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