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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495061
Report Date: 10/20/2022
Date Signed: 10/20/2022 03:11:15 PM

Document Has Been Signed on 10/20/2022 03:11 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:DIXON FAMILY CHILD CAREFACILITY NUMBER:
197495061
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 10DATE:
10/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Tabina Dixon, LicenseeTIME COMPLETED:
03:25 PM
NARRATIVE
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On 10/20/2022 at 10:25am, Licensing Program Analyst Adrian Risher conducted a case management inspection regarding a cross report from Children’s Residential. LPA Risher conducted the visit with Licensing Program Analyst Dawn Mahecha from Children’s Residential. LPA Risher and LPA Mahecha met with Licensee Tabina Dixon and explained the purpose of the visit. At the time of the visit, LPA Risher observed 10 children in care with 1 Assistant

On 10/14/2022, ESCCRO received a cross report regarding an incident that occurred with the Licensee. Licensee is also a Resource Parent with a Residential Family Home. Information was reported that the Licensee has 2 different residencies for the Family Child Care Home and Residential Family Home.

On 10/20/2022, LPA Risher observed 10 children in care with 2 staff. LPA verified the ages of the children in care. Licensee stated 3 of the children were foster children. Licensee stated that she is waiting for the foster children to be placed in daycare. Licensee called Mr. Hatch, Social Worker, during inspection and he confirmed that the children have been approved for placement in daycare. Mr. Hatch was unable to provide an exact date when the children will be placed in daycare. Licensee was reminded she is licensed for 8 and arrangements need to be made for any additional children to maintain capacity.

During the inspection, LPA observed Assistant 1 in the living room with 5 children. Licensee stated that Assistant 1 has been volunteering at the daycare for about 3 weeks. Assistant 1 volunteers at the daycare 3 to 4 times a week. Licensee was reminded that a criminal background check is required prior to any adult working, residing or volunteering at the home.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 10/20/2022
NARRATIVE
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Based upon observations and interviews conducted by LPA, Licensee is in violation of the Title 22 regulations: 102370 and 102416.5. LPA Risher observed Assistant 1 in the home without a criminal record clearance. LPA Risher observed 10 children in care.

Licensee will be cited for 2 deficiencies today fro Criminal Record Clearance and Staffing Ratio & Capacity. LPA advised Licensee the Criminal Record Clearance Type A citation will include a civil penalty of $500 per person. Allowing any person who is subject to a background check to work, reside or volunteer who does not have either a criminal record clearance or exemption is a violation of section code 102370(d). A civil penalty shall be assessed for a maximum of 5 days for the first violation. For subsequent violations within a 12 month period, a civil penalty shall be assessed for a maximum of 30 days. Please refer to section code 102370(e)


Licensee was advised that each parent or child representative must sign the LIC 9224 Acknowledgement of Receipt of Licensing Report and return by the close of the business day or upon the next day the child returns to the facility or upon a newly enrolled child within the next 12 months and place the LIC 9224 in each child's file.

Licensee was provided with a copy of the Request for Live Scan form LIC9163 and Criminal Record Clearance Transfer Request LIC9182.

Licensee was reminded that she is licensed for a capacity of 8. The licensee's application for an increase in capacity is still pending.

Exit interview was conducted and a copy of the report was provided to Licensee Tabina Dixon. Appeal rights were reviewed and provided.

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

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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Document Has Been Signed on 10/20/2022 03:11 PM - It Cannot Be Edited


Created By: Adrian Risher On 10/20/2022 at 01:32 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 197495061

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2022
Section Cited
CCR
102416.5(c)

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102416.5 Staffing Ratio and Capacity The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.
This requirement was not as evidenced by: LPA Risher observed 10 children in care.
This is an immediate risk to the Health & Safety of the children in care
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Licensee was advised to have some of the children be picked up by their parents to get back in compliance. Licensee will write a declaration explaining how she will maintain capacity and ratio moving forward. Licensee will submit the declaration to LPA by 10/27/2022
Type A
10/21/2022
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department ...
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LPA provided Licensee with a copy of Live Scan form(LIC9163) for Assistant 1. Licensee will have Assistant 1 complete a Live Scan and provide LPA with receipt by 10/21/2022.
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This requirement was not met as evidenced by: LPA observed Assistant 1 in the home without a criminal record clearance. This poses an immediate risk to the Health & safety of the children in care.
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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:Maureen Neal
LICENSING EVALUATOR NAME:Adrian Risher
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


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