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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495061
Report Date: 03/03/2022
Date Signed: 03/03/2022 11:39:59 AM

Document Has Been Signed on 03/03/2022 11:39 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DIXON FAMILY CHILD CAREFACILITY NUMBER:
197495061
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Tabina Dixon LicenseeTIME COMPLETED:
11:45 AM
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On 3/3/2022, Licensing Program Analyst (LPA), Adrian Risher conducted a pre-licensing inspection for a family child care home relocation. LPA met with applicant Tabina Dixon at 10:10am and toured the facility. The applicant and one of her daughters were present at the time of the inspection. LPA did not observe any children present. The home is clean, orderly and comfortable. The adults in the home have been fingerprinted and associated to the facility. The hours of operation will be 7:00am to 6:00pm Monday thru Friday. Applicant is requesting to have a family child care home with a capacity of 8.

The single family home has 3 bedrooms and 2 bathrooms. The daycare will be in the bonus room which is located in the back of the home. These areas were inspected by LPA. The other bedrooms and rooms are considered off-limits and inaccessible. Applicant is renting the home. Applicant provided property owner/landlord consent form with the application. The parents will enter home from the back entrance. LPA observed mats which will be used for napping. Licensee stated that she will purchase a pack n play for infants. LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children. The area in front of the closet will be used as the isolation area for ill children.

LPA observed age appropriate toys, furniture and activities for children while in care at the facility. Licensee stated that the yard will be off limits until she is done setting up the play equipment for the yard and cleaning it up. LPA observed a brick wall all around the outside play area. Licensee will provide pictures of the yard once it is complete. LPA did not observe any bodies of water.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 197495061
VISIT DATE: 03/03/2022
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LPA observed a charged fire extinguisher (2-A:10-B:C). LPA tested the smoke detector and carbon monoxide detector. Applicant has a first aid kit which includes band aids and a thermometer. The home has central air and heat. Per the applicant, there are no firearms on the premises. Applicant has one dog. LPA did not observe any baby walkers, exersaucers or bouncers. Applicant will provide a copy of her cpr card. LPA received a copy of mandated reporter certificate. Applicant will provide a copy of immunization record.


The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible.


The following corrections were discussed with applicant in order for the home to be ready for conducting child care:

1. heater: inoperable letter or place a gate around it 3. copy of immunization's
2. Latch on bathroom cabinet 4. copy of cpr card

A license to operate a Small Family child care home will be reviewed following final administrative review, and receipt of outstanding corrections needed. No license will be issued today 3/3/22. Applicant will notify LPA when corrections have been made, and the Applicant has 30days to complete corrections.

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.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
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: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 197495061
VISIT DATE: 03/03/2022
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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 also informed applicant 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.

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



Exit interview conducted and report was reviewed with the applicant Tabina Dixon.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

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

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.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC809 (FAS) - (06/04)
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