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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495545
Report Date: 02/27/2025
Date Signed: 03/07/2025 08:44:31 AM

Document Has Been Signed on 03/07/2025 08:44 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DIXON FAMILY CHILD CAREFACILITY NUMBER:
197495545
ADMINISTRATOR/
DIRECTOR:		TABINA DIXONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 343-3990
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/27/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:34 AM
MET WITH:Tabina DixonTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 02/27/2025 Licensing Program Analyst (LPA) Ranita Richmond conducted an ANNOUNCED PRE-LICENSING INSPECTION with applicant Tabina Dixon. Nashia McDaniel was present during the visit. LPA confirmed with applicant that hours of operation will be 7am- 6pm, Monday through Friday. Applicant is not open for overnight or weekend care. Applicant will provide meals, snacks, and water. Applicant provides transportation from Manhattan Place Elementary and Cimmaron Elementary in the afternoon daily as needed. Applicant provided registration and insurance information for 2019 Dodge Caravan and copy of California driver’s license.

The home was toured with the applicant for a health and safety inspection. LPA observed 8 children being cared for and supervised during visit.

The current facility sketch was reviewed, and LPA Richmond confirmed that home is a back house on a lot of two houses and consists of the following: living room, kitchen, dining room, 3 bedrooms, 2 bathrooms, and fenced front yard.

The Applicant has requested the following rooms be ON-LIMITS: living room (main day care area/napping), dining room (eating area), bathroom #1, kitchen(walk thru only), and the fenced front yard. The ISOLATION AREA will be in the dining room.

The applicant has requested the OFF-LIMIT AREAS are as follows: bedrooms 1, 2, & 3, and bathroom #2.

The parents and children walk to the back of the lot, through the driveway to approach the home. Parents and children will enter the home through the front door. Upon entrance you are in the living room. Through the living room to the left is the kitchen. Through the kitchen is the dining room. Inside the dining room is a sliding door that leads to the side of the home, outside area. Walking Through the living room straight ahead is a hallway that leads to bathroom #1 slightly to the right. Bedroom #1 is farther to the right. Inside bedroom #1 is bathroom #2. In the hallway to the left is bedroom #2, and farther to the left is bedroom #3.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 197495545
VISIT DATE: 02/27/2025
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The home is neat and clean with heating and ventilation for safety and comfort. The FCCH has a working phone and LPA Richmond confirmed the number is 310-***-****.

The home has working a carbon monoxide detector in the hallway. The home has working smoke detectors throughout. The home has a fully charged 4A80BC Fire Extinguisher in the living room. The home is equipped with a pull fire alarm system, last checked by fire marshal on 2/25/25.



There are no pools, ponds, spas or other bodies of water on the property. All poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are made inaccessible to children in care by being housed in locked and off limits areas.

There are no guns or ammunition stored on the premises. Applicant has a 7year old Yorkie, Callie that remains in a dog cage in the dining room during business hours.

LPA Richmond observed age-appropriate toys, books and furnishing and equipment that are in good condition, free of sharp, loose or pointed parts.

The Applicant has current CPR/First Aid certificates and Mandated Reporter Training certificates and is in compliance with the immunization law which pertains to day care providers. LPA Richmond reminded applicant that the CPR/First Aid and Mandated Reporter training are to be updated every 2 years.

The applicant provided a copy of CA drivers license for all adult residents during visit to be placed in file.

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-and­resources/safesleep as an additional resource. LPA Richmond informed applicant of the importance of checking for recalled infant devices on the United States Consumer Products 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 the purchased equipment.



California Law requires Family Child Care Home applicants to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. Please report Telephone number changes and/or if you move from home.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 197495545
VISIT DATE: 02/27/2025
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA provided applicant with 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. LPA Richmond gave applicant a packet of all required forms, and posters and reviewed following forms:

CHILDREN'S RECORDS REQUIREMENTS:

· LIC 700 Identification and Emergency Information


· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· LIC 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights
· Immunization Record

FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 197495545
VISIT DATE: 02/27/2025
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FORMS TO BE POSTED
· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

In addition, LPA Richmond informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Applicant was reminded of Departments inspection authority, with or without any notice.

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



Applicant 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.
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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIXON FAMILY CHILD CARE
FACILITY NUMBER: 197495545
VISIT DATE: 02/27/2025
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Prior to licensing, applicant will make the following corrections, on or before 3/13/2025:
· Lock on shower door in bathroom #1
· Guardian transfer of fingerprint clearance for applicant and staff (Nashia McDaniel and Teresa Gray)
· Applicant will provide copy of liability insurance for home
· Applicant will provide copy of auto insurance policy for 2019 Dodge Caravan
· Shot records for the dog ( Yorkie Callie)



An exit interview was conducted, and report was reviewed and provided to applicant Tabina Dixon.


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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
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