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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191803292
Report Date: 12/17/2025
Date Signed: 12/17/2025 12:19:14 PM

Document Has Been Signed on 12/17/2025 12:19 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:NICHOLS FAMILY CHILD CAREFACILITY NUMBER:
191803292
ADMINISTRATOR/
DIRECTOR:		DOROTHY NICHOLSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 754-0504
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 12TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
12/17/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Dorothy NicholsTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced Required 3 year inspection on 12/17/2025. LPA was greeted by the husband of licensee. LPA introduced self and explained the nature of the visit. Licensee was not present during the initial start of the inspection. Husband of the licensee gave LPA a tour of the home. LPA observed Facility License and Notification of Parents Rights posted on wall in the den (main childcare area), Earthquake Preparedness form was not posted. LPA reviewed the Emergency Disaster Plan LIC610A, however the temporary relocation sites #4 were blank. LPA requested licensee to complete the LIC610A in its entirety and submit a copy to the Regional Office. LPA observed a Disaster and Fire Drill Log (last fire drill conducted on 12/06/2025) per documentation. LIC9040 Facility Roster was observed with 6 school age children enrolled. Licensee only has school age children enrolled at this time. Licensee returned to the home and concluded the inspection with LPA around 11:00pm. Licensee viewed the Entrance Checklist via computer.
The facility operating hours/days are Monday through Sunday from 6:00am to 7:00pm. This is a one-story home. Per Licensee one other adult reside in the Family Child Care Home. All Adults present, residing and working in the home are fingerprint cleared and associated with the facility. No children were present during inspection. Licensee transports children to and from school. LPA observed a current driver license and auto mobile insurance card during inspection.
The On-Limit areas of the home are, the den, living/dining room, bathroom located in the hall and bedroom #1 The children also use the front yard for outdoor activities.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NICHOLS FAMILY CHILD CARE
FACILITY NUMBER: 191803292
VISIT DATE: 12/17/2025
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The Off-Limit areas of the home are, Kitchen, attached garage, 2 rear bedrooms and rear bathroom all bedrooms are made inaccessible by key/or turn locks. The kitchen is made inaccessible by a child gate in front of entry door.

The isolation area is in the living room, per licensee.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Home utilizes central air and heating for a cooling and heating source. Home has a working telephone phone number has been verified. Hazardous materials in the kitchen and bathroom are inaccessible to children by child gate. According to the Licensee, there are no weapons or firearms at the home; None were observed by LPA. Per Licensee, the home has two birds which are in cages located inside of the attached garage.

LPA observed a fire extinguisher which is at least 2A:10BC, has been serviced. Next service will be due February of 2026. LPA reminded licensee that the fire extinguisher must be serviced yearly, or a new fire extinguisher must be brought. The home is also equipped with a working smoke detector and carbon monoxide detector which were tested during inspection. There is also a first aid kit equipped with needed essentials in the home. LPA observed current First Aid and CPR certificates for Licensee with an issued date of 05/18/2024. Assistant has completed Mandated Reporter training on 03/12/2025.

LPA observed toys and playthings which appeared to be safe for children in care and age-appropriate for the children. LPA observed a large table and television mounted on wall in den with couches in the room. LPA observed a large refrigerator and television camera (surveillance of outside of home) located in the den. Licensee agrees that no baby-walkers, bouncers, jumpers, exersaucers and similar items will be used for children in care and are kept inaccessible; None were observed by LPA.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NICHOLS FAMILY CHILD CARE
FACILITY NUMBER: 191803292
VISIT DATE: 12/17/2025
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Per licensee the outside play for the children is conducted in the front off the home licensee states the back yard is off limits. The front and backyard are completely fenced. Per Licensee, supervision of the children is always provided by Licensee and Assistant(s) during outside play time and front gate locked. The outside play area is free from defects or dangerous conditions. No pools, spas, hot tubs, fish ponds, or similar bodies of waters observed during the inspection. LPA did observe a trampoline located on the grass in the front yard.

LPA reviewed 3 children's files during today's inspection and observed the following Children's Records: Immunization Records, LIC 700 (Identification and Emergency Information), LIC 627 (Consent for Emergency Medical Treatment), LIC 995A (Notification of Parents' Rights). However the enrollment form for school age children were not in files. LPA gave licensee a technical violation and all files will obtain the enrollment forms by January 13th 2026.

Criminal Record Clearance- Licensee Dorothy Nichols 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.

LPA discussed the safe sleep regulations with licensee Dorothy Nichols 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 Nichols of the importance of checking for and removing any 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.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NICHOLS FAMILY CHILD CARE
FACILITY NUMBER: 191803292
VISIT DATE: 12/17/2025
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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/.

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

During the exit interview, the Licensee Dorothy Nichols, confirmed that there are no Registered Sex Offenders living in the facility and LPA will complete the RSO profile in FAS.

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.

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

Exit interview conducted and report was reviewed with the licensee Dorothy Nichols.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC809 (FAS) - (06/04)
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