<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407805
Report Date: 10/09/2019
Date Signed: 10/09/2019 10:38:32 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: DATE:
10/09/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gina Henderson, LicenseeTIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 9, 2019 at 9:00 AM, Miriam Cohen, Licensing Program Analyst (LPA) conducted an Annual/Random inspection at Henderson Family Child Care Home, 197407805 located at 28319 Pontevedra Drive, Rancho Palos Verdes, CA 90275 utilizing Kit 2 guidelines. Per the Licensing Information System (LIS), all adults residing or working in the home have obtained criminal background clearances.
The following were observed during the inspection:
Walk Through
LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises. Per the assistant, there are no weapons or firearms on premises. LPA observed all poisons, detergents, cleaning compounds, medications and other items which can pose a threat to children in care made inaccessible.
LPA observed a properly barricaded fire place/wall heater. LPA did not observe any staircases which required barricading. LPA observed the home to provide safe toys, play equipment, and materials. LPA observed the home with fire extinguisher, smoke alarm, and carbon monoxide detector in working condition which meet the State Fire Marshal standards.
Care and Supervision
LPA observed adequate care and supervision during the course of the inspection. Six children (three infants and three preschool age) were in care of two adults. LPA did not observe children in kindergarten or elementary school age or one child at least age six. LPA did not observe any children to be left in parked vehicles. LPA observed each child to have safe, healthful, comfortable accommodations, furnishing and equipment.
Record Review
LPA observed the home to have a current child roster. Fire and disaster drills are conducted multiple times throughout the year. LPA observed a random sample of children files to be complete and in compliance with Title 22 Regulations.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197407805
VISIT DATE: 10/09/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Administration
LPA observed licensee and staff Munguia to have current Pediatric First Aid and CPR (expires 01/2021).
LPA observed the first aid kit to have adequate material. LPA discussed Incidental Medical Services with the licensee. LPA provided additional information pertaining to IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
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.
*The role and responsibilities of being a mandated reporter were discussed. 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 their 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 has changed, licensing must be notified.
*Regulation prohibits the smoking of tobacco on the premises.
*State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. All infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). The provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.
*Only children eating may be in high chairs and that car seats are utilized only for transportation
*Licensee was advised that there is to be no sleeping, napping, eating in a garage or detached room(s). Under no circumstances shall a child take naps or be left in a car seat. Children shall nap on flat comfortable surfaces without any debris to prevent injury or trauma.
*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 (5 days) for the 1st offense and up to $3000.00 for the 2nd offense within a 12-month period.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197407805
VISIT DATE: 10/09/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
*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.
*The "Notification of Parent's Rights" (PUB394) poster must be posted in an area accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.
*The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541 Email Address: childcareadvocatesprogram@dss.ca.gov

*Report suspected Child Abuse at 1-800-540-4000. In addition, contact the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).


*ALL ADULTS without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day, per person. Criminal record clearances (LiveScan/fingerprinting) are required for all adults living, working, volunteering or frequently visiting during the hours of day care in the Family Child Care prior to their presence in the home. A civil penalty of $100.00 will be assessed per day If any person(s) who have not been cleared is present in the home during hours of operation.
New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. Appeals may be mailed to the following address:
El Segundo Child Care Program Regional Office
300 N Continental Blvd., Suite 290A MS, 29-13
El Segundo, CA 90245

The On Duty officer is available to answer questions Monday – Friday at (424) 301-3014. LPA addressed with the licensee Senate Bill 792 that indicates that a person employed or volunteering at a child care facility requires immunization against influenza, pertussis and measles. Please visit the DSS-CCLD website for more pertinent information www.ccld.ca.gov.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
LIC809 (FAS) - (06/04)
Page: 3 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197407805
VISIT DATE: 10/09/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Per the California Title 22 Regulations, the facility is operating in compliance and shall NOT be cited a Type “A” or “B” deficiency on 10/09/2019.

An exit interview was discussed and conducted.

A copy of this report was read, signed, and provided to the licensee, Gina Henderson, on this date.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4