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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400907
Report Date: 12/17/2024
Date Signed: 12/17/2024 11:01:59 AM

Document Has Been Signed on 12/17/2024 11:01 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DICKERSON FAMILY CHILD CAREFACILITY NUMBER:
198400907
ADMINISTRATOR/
DIRECTOR:		DICKERSON, ANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 200-8647
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
12/17/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:DICKERSON, ANITA / LICENSEETIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Ashley Calderon conducted Case Management Annual Continuation visit and following up on an Unusual Incident Report that was reported to the Department on 12/02/24 and met with Licensee Anita Dickerson. LPA disclosed the purpose of the inspection and was granted entry into the facility by Licensee.

During today's visit LPA Calderon conducted tour of the on limit areas to the children: Kitchen and Living room. LPA completed Care Tool inspection tool.

LPA discussed with Licensee records for Child #1 (C1), incident involving Child #1. Licensee took safety measures to ensure Child #1 was safe. LPA discussed Child Records Regulation.

Based on today’s visit, Per California Code of Regulation Title 22 no citations were given today.

A notice of site visit was given to Licensee and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Anita Dickerson.


SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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