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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334815242
Report Date: 01/13/2023
Date Signed: 01/13/2023 10:25:52 AM

Document Has Been Signed on 01/13/2023 10:25 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:DIXON FAMILY CHILD CAREFACILITY NUMBER:
334815242
ADMINISTRATOR:DIXON, HEATHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 461-8504
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
01/13/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Heather DixonTIME COMPLETED:
10:35 AM
NARRATIVE
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Licensing Program Analysts (LPAs) James Wilkerson and Ana Noble arrived at this facility and observed two female uncleared adults. One uncleared adult was assisting in the child care and stated that he/she had been here over five times total assisting in the day care. Another uncleared adult is the licensee's adult child who lives in the home and neither have received their criminal record clearances.

See LIC 809D for deficiencies cited per Title 22 Regulations.

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 for the next 12 months.

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

A Civil Penalty has been assessed on this visit. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

An exit interview was conducted, appeal rights discussed and provided on this date along with a copy of form LIC 9224 (AB 633) and a copy of this report on this date.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2023
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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Document Has Been Signed on 01/13/2023 10:25 AM - It Cannot Be Edited


Created By: James Wilkerson On 01/13/2023 at 10:01 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 334815242

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2023
Section Cited
CCR
102370(a)

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Criminal Record Clearance - (a) Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement was not met as evidenced by: two female uncleared adults in the facility. Ond adult asisting in the day care for over five days and an adult
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LIcensee agrees to have her uncleared assistant and adult child to Livescan to get fingerprinted for criminal record clearances.
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child of the lviing in the home. Neither of whom have received criminal record clearances or exemptions.
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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:Carlos Martinez
LICENSING EVALUATOR NAME:James Wilkerson
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


LIC809 (FAS) - (06/04)
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