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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407805
Report Date: 05/23/2019
Date Signed: 05/23/2019 09:27:30 AM

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:HENDERSON FAMILY CHILD CAREFACILITY NUMBER:
197407805
ADMINISTRATOR:HENDERSON, GINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 832-8890
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY:14CENSUS: 2DATE:
05/23/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Gina Henderson, LicenseeTIME COMPLETED:
10:00 AM
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On May 23, 2019 at 8:30 AM, LPA Cohen conducted an announced plan of correction inspection for the purpose of observing corrections to deficiencies discussed during the Non-Compliance Conference held at the El Segundo Child Care Regional Office on Feb 15, 2019.

The licensee agreed to the following in order to bring the facility into compliance:
*Remain in substantial compliance and operate the facility according to the Laws, Rules and Regulations, specifically noted for Family Child Care Regulations for Title 22 Division 12 chapter 3
*Facility will be placed on Required Inspection on a quarterly basis for the next 12 months to ensure compliance with Regulations.

Licensee, Gina Henderson, is required to operate the facility in full compliance with Title 22 Regulations and Health and Safety Code requirements in general and specifically pertaining to: Staffing Ratio and Capacity, Criminal Record Clearance, Operation of an FCCH, Mandated Reporter, and Personnel Requirements.

During today’s inspection, LPA Cohen observed two infants being supervised by Gina Henderson, Licensee.
A copy of this Facility Evaluation Report has been explained and discussed and provided to the licensee.

This report must be posted for 30 days from today,
This report was read, discussed, and signed during this inspection.

Exit interview conducted and Notice of Site Visit was provided to licensee, Gina Henderson.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
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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