Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415902
Report Date: 07/14/2016
Date Signed 07/14/2016 03:23:03 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:DICKINSON FAMILY CHILD CAREFACILITY NUMBER:
197415902
ADMINISTRATOR:DICKINSON, MICHELLE L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 386-2373
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY:14CENSUS: 17DATE:
07/14/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Michelle Dickinson/LicenseeTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Trevino Cochran and Silva Garibyan met with licensee, Michelle Dickinson, who guided analyst on a tour of the facility for a Random visit. The licensee was present with 17 children and two assistants. This is a one story, three bedroom, one bathroom home with kitchen/dining, living room. The garage is used as a playroom/classroom. The garage has not been fully converted and the licensee is fully aware that children may not eat or sleep in the garage. Children eat and sleep in the living room. There is no pool, spa on the premises. Family members residing in the home include 2 adults (licensee and spouse) and 2 teenage children ( 16 and 14 years old).
Main care is provided in the living room. Children use the bathroom located next to the licensee's bedroom.. Children have access to the dining area and backyard. LPAs inspected the only bathroom and 3 bedrooms. The home was found to have proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. Kitchen cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. LPAs observed cleaning chemicals and beauty supplies accessible in kitchen and bathroom cabinets.
No Parents Rights Poster posted
No Facility Roster available for review
No Immunization records available
Children play in the backyard. There is a storage room attached to garage (inaccessible to children, with a locked door) on the side of the yard. There is a grass area with age appropriate toys for playing. Plants and debris need to be cleaned out and made inaccessible to children. Large open hole at rear of backyard near gate. Large hole needs to be covered or filled and made in accessible to children. Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPAs did not observe any weapons. There are age appropriate toys and napping equipment on the premises. Children nap in playpens and mats in the main care area. The required fire extinguisher (2A10BC) and smoke detectors are in operable condition. The home has a Carbon Monoxide detector. Home has central AC and heat. The First Aid kit was observed and is complete. Licensee has posted as required the License, Emergency Disaster Plan. Licensee's was unable to demonstrate current proof of CPR/First Aid Certificates. Licensee's assistant's CPR/First Aid expire 10/2017.


SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/04/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: DICKINSON FAMILY CHILD CARE
FACILITY NUMBER: 197415902
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/21/2016
Section Cited
102416(c)
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:Licensee is required to maintain current Pediatric CPR and First Aid certifications at all times..
Licensee was unable to demonstrate current proof of CPR/First Aid Certificates
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Licensee will provide proof of current Pediatric CPR & Pediatric First Aid certifications or registration for by 07/21/2016
Type B
07/21/2016
Section Cited
102418(g)
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102418(g) Immunization. Licensee shall document and maintain each child’s immunization's as long as the child is enrolled.
LPA reviewed childrens files and observed missing immunization records.
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Licensee will fax or mail copies of Immunization records for the children by 7/21/2016. Licensee will keep documents of the immunization records in each child's file.
Type B
07/21/2016
Section Cited
102419(b)
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102419(b) Parents Rights. The Licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in an accessible area in the family child care home at all times children are in care.
PUB 394 was not posted in the facility
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Licensee to post and take picture and send to LPA via email, scan or fax by 7/21/2016 .
Type B
07/21/2016
Section Cited
102417(g)(8)
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102417(g)(8) Operation of a Family Child Care Home. All homes shall have a current roster of the children.
The licensee did not have a Facility Roster that included the ages of the children or their enrollment/last date in care.
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Licensee to post and take picture and send to LPA via email, scan or fax by 7/21/2016.
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: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: DICKINSON FAMILY CHILD CARE
FACILITY NUMBER: 197415902
VISIT DATE: 07/14/2016
NARRATIVE
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The following was discussed with the licensee:

Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home 7 days a week, 24 hours a day. State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.


Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" (2015) poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).
Licensee was advised to visit www.shotsforschool.org for Immunization information. SB 277 - require all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions.

Incidental Medical Services were discussed. Per assistant there are no children enrolled that receive incidental medical services.

An exit interview was conducted and a copy of this report was provided to the licensee on 07/14/2016
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2016
LIC809 (FAS) - (06/04)
Page: 2 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: DICKINSON FAMILY CHILD CARE
FACILITY NUMBER: 197415902
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2016
Section Cited
102416.5(a)
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102416.5(a) Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.
Licensee was present with 17 children and 2 assistants.
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Corrected during visit. Licensee Assistant took her 3 children home. POC will be conducted
Type A
07/14/2016
Section Cited
102417(g)(4)
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102417(g)(4) Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. LPA's also observed tools, and scissors on kitchen counter.
LPA's observed sharp items and debris in backyard.
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Corrected during visit. Licensee locked door where chemicals are stored. Licensee must make all chemicals inaccessible to children.
Licensee removed scissors, and tools.
All sharp items, pointy objects and harmful debris will be removed from outside/backyard.
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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: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2016
LIC809 (FAS) - (06/04)
Page: 3 of 4