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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197403561
Report Date: 05/27/2021
Date Signed: 05/27/2021 05:28:07 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2021 and conducted by Evaluator Miriam Cohen
COMPLAINT CONTROL NUMBER: 30-CC-20210324134820
FACILITY NAME:HENRY FAMILY DAY CAREFACILITY NUMBER:
197403561
ADMINISTRATOR:HENRYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 325-9373
CITY:HARBOR CITYSTATE: CAZIP CODE:
90710
CAPACITY:14CENSUS: 9DATE:
05/27/2021
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Verna Henry, LicenseeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Licensee is not providing adequate supervision.
Infant was left in car seat with propped up bottle.
INVESTIGATION FINDINGS:
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This report is being delivered electronically per Tele-Visits Procedure for COVID-19.
On 05/27/2021 at 12:35 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced virtual visit and met and informed Verna Henry, licensee, of the reason for the visit: Delivery of report finding against the alleged complaints. After conducting virtual interviews and obtaining written declarative statements, the following conclusions have been reached:
1. Licensee is not providing adequate supervision
Based upon the following observations below, facts revealed that there is a preponderance of evidence to support that the facility mentioned above does not provide adequate care and supervision:
a) Virtual interview with Child #2 (C2) – observation of an infant in a crib crying and at the same time covered with a blanket (licensee and staff members failed to ensure the personal rights of a child).
b) Video taken by C2 as viewed by parent and three staff members of the Community Center Development (CDC agency) – heard audible sound of an infant crying and gasping for air but did not hear any audible sound indicating that there was an adult present to comfort or console the infant (video provided sound only; image of people were not visible). Therefore, the following conclusion has been reached concerning allegation #1: Substantiated - A finding that a complaint is substantiated means that the allegation is valid
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 30-CC-20210324134820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HENRY FAMILY DAY CARE
FACILITY NUMBER: 197403561
VISIT DATE: 05/27/2021
NARRATIVE
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2. Infant was left in car seat with propped up bottle.
Based upon the following observation below, fact revealed that there is a preponderance of evidence to support that an infant was left in a car seat with propped up bottle:
a) Virtual interview with C2 – observation of an infant sitting in a car seat drinking milk while bottle was propped up by a blanket.
Therefore, the following conclusion has been reached concerning allegation #2: Substantiated - A finding that a complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

The facility was cited three Type A deficiencies according to California Code of Regulations Title 22 (See LIC 9099D). A copy of this report and LIC 9224 must be given to all parents and to the parents of any child enrolling within the next 12 months. Appeal Rights were provided and explained to licensee. LIC 9213- Notice of Site Visit provided and must be posted for 30 days. Failure to do so for 30 consecutive days will result in immediate civil penalty assessment of $100. Exit interview conducted and discussed with licensee. Ms. Henry was advised that an email will be sent with the report attached, which has been reviewed during the tele-visit. Ms. Henry was further counseled that a read receipt via email shall be considered an acknowledgement that she is in receipt of this report and understand her licensing appeal rights as explained.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 30-CC-20210324134820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HENRY FAMILY DAY CARE
FACILITY NUMBER: 197403561
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2021
Section Cited
CCR
102423(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment.
This requirement is not met as evidenced by witness interviews and written statement demonstrating that the licensee and staff workers failed to ensure the personal rights of a child. Child #2 reported that an infant was
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1. Licensee agrees to view Child Care Videos (https://ccld.childcarevideos.org/family-child-care-providers/) for Providers and Parents with specific topic related to the following:
*Children’s Personal Rights in Childcare
2. Licensee agrees to write a summary for the topic viewed.


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observed sitting in a car seat drinking milk while bottle was propped up by a blanket. Child #2 stated that an infant was observed crying in a crib covered with a blanket. These pose an immediate risk to the health, safety, and personal rights of children in care.

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3. Licensee agrees to view the video, write a summary, and send a copy of summary to LPA Cohen, via email, by 06/18/2021, end of business day.
Type A
05/27/2021
Section Cited
CCR
102417(a)
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Operation of a Family Child Care Home
The licensee shall be present in the home and shall ensure that children in care are supervised at all times.
This requirement is not met as evidenced by a witness stating that an infant was observed left crying in a crib.
This requirement is not met as evidenced by a
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1. Licensee agrees to view Child Care Videos (https://ccld.childcarevideos.org/family-child-care-providers/) for Providers and Parents with specific topic related to the following:
*Supervising Children in Family Child Care Home
2. Licensee agrees to write a summary for the topic viewed.
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video footage (sound only; image of people not visible), as observed by witnesses, revealing an audible sound of infant crying and gasping for air. There was no audible sound indicating a presence of adult comforting the infant.
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3. Licensee agrees to view the video, write a summary, and send copy of summary to LPA Cohen, via email, by 06/18/2021, end of business day.
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 NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 30-CC-20210324134820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HENRY FAMILY DAY CARE
FACILITY NUMBER: 197403561
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2021
Section Cited
CCR
102425(h)
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Infant Safe Sleep
Car seats shall only be used for transportation purposes…
This requirement is not met as evidenced by a witness declaring that an infant was observed sitting in a car seat drinking milk while bottle was propped up by a blanket.
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1. Licensee agrees to view Child Care Videos (https://ccld.childcarevideos.org/family-child-care-providers/) for Providers and Parents with specific topics related to the following:
*SAFE SLEEP (click on link below)
.

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https://www.cdss.ca.gov/Portals/9/Safe%20Sleep%20Reference%20Document%20Final.pdf?ver=2018-04-30-142717-390
2. Licensee agrees to write a summary for the topic viewed.
3. Licensee agrees to view the video, write a summary, and send copy of summary to LPA Cohen, via email, by 06/18/2021, end of business day.

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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 NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2021 and conducted by Evaluator Miriam Cohen
COMPLAINT CONTROL NUMBER: 30-CC-20210324134820

FACILITY NAME:HENRY FAMILY DAY CAREFACILITY NUMBER:
197403561
ADMINISTRATOR:HENRYFACILITY TYPE:
810
ADDRESS:1136 FERNREST DRIVETELEPHONE:
(310) 325-9373
CITY:HARBOR CITYSTATE: CAZIP CODE:
90710
CAPACITY:14CENSUS: 9DATE:
05/27/2021
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Verna Henry, LicenseeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Adults without criminal background clearance supervising children.
INVESTIGATION FINDINGS:
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This report is being delivered electronically per Tele-Visits Procedure for COVID-19.
On 05/27/2021 at 12:35 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced virtual visit and met and informed Verna Henry, licensee, of the reason for the visit: Delivery of report finding against the alleged complaint. After conducting virtual interviews, the following conclusion has been reached:
1. Adults without criminal background clearance supervising children.
Based upon the following observations below, facts revealed that, there is not a preponderance of the evidence to support that adults without criminal background clearance supervise children:
a) Virtual interviews with three children currently enrolled in daycare – all staff workers identified by children have criminal record clearance listed and verified in LIS.
b) Virtual interviews with three parents of children currently enrolled in daycare – all staff workers identified by parents have criminal record clearance listed and verified in LIS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 30-CC-20210324134820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HENRY FAMILY DAY CARE
FACILITY NUMBER: 197403561
VISIT DATE: 05/27/2021
NARRATIVE
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c) Virtual interviews with two staff workers – all staff workers identified have criminal record clearance listed and verified in LIS.
d) Virtual interview with a staff member from CDC – during a physical plant inspection, adults present in the facility have obtained a criminal record clearance as observed by a CDC staff member.
Therefore, the following conclusion has been determined concerning the allegation: Unsubstantiated - A finding that the complaint is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6