198004787-6-10-2022-33-CC-NTCG-CF9PPH-20220610112936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004787
Report Date: 06/10/2022
Date Signed: 06/10/2022 11:29:43 AM

Document Has Been Signed on 06/10/2022 11:29 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	HENRY FAMILY CHILD CARE HOME		FACILITY NUMBER:	198004787
ADMINISTRATOR:	HENRY, MARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 593-2672
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY:	14	CENSUS: 7	DATE:	06/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Mary Henry - Licensee		TIME COMPLETED:	11:42 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	Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced 5-Year inspection to the above facility. At 8:50am, LPA met with licensee, Mary Henry. Also present during this inspection is Licensee’s Assistant. The licensee states that she currently has 9 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 7am-5:30pm, Monday-Friday. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, activity room, front yard and backyard (fenced). The children use the small bedroom, bathroom in hallway, kitchen, living room, activitiy room, dining room area and backyard. Per licensee, areas off limits to children and parents include: 2 bedrooms, bathroom attached to off-limit bedroom, and front yard. All areas identified on the facility sketch were inspected. The licensee provides food for children in care. The licensee states that 2 adults and 0 children currently live in the home. All persons living in home are identified on attached LIC811. Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises. PHYSICAL PLANT At 9am, LPA was lead on a tour of the facility by the licensee. Upon entry into the home, there is an off limit living room area that is made inaccessible to the children in care. There is a fireplace that is made inaccessible by cover and child lock. The tour continued into the dining area where there was the required publications posted. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. The kitchen is adjacent to the dining area. The sharp knives are kept high on a shelf and out of reach of children in care. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The licensee states that there is a land line on the premises. REPORT CONTINUES PAGE 1 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
	VISIT DATE: 06/10/2022

NARRATIVE

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At a 9:07am, a fire extinguisher was observed on the kitchen counter near the wall. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 12/31/21, as indicated on the receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Tour continued to the hallway where there are two bedroom doors made inaccessible to children in care by door knob, child proof covers. At 9:15am, smoke and carbon monoxide detectors were tested and are operable. The bathroom was reviewed and observed to be safe and free of hazards. Cabinets under the sink have child locks. The next areas observed were the child care activity areas that have age appropriate toys, equipment and materials. There are first aid supplies available. Per licensee, the dining area will be used as an area for an ill child until an authorized representative comes to pick up child.

At 9:25am, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There is a grass area, "playhouse" used as a drama area, climbing structure, garden, small playhouses, and bikes for children to use. There is also an old chicken coop that is not in use and is sealed off. Licensee plans to have it converted to a play space for the children.

FACILITY RECORDS:

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 01/2024 Licensee and other personnel have complete mandated reporter training that expires 03/10/2024. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

The following was discussed:

-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There are two large dogs on the premises. They are accessible to children in care. Animal feces are checked for before children go outside to play.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home. REPORT CONTINUES PAGE 2 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
	VISIT DATE: 06/10/2022

NARRATIVE

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Infant Care: Licensee states that they are not caring for infants at this time. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the same room as other children in care. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):

The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. 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.

LPA observed COVID Health and Safety protocols being followed at facility. Staff were wearing face masks and children have their own labeled bottles.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

REPORT CONTINUES PAGE 3 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
	VISIT DATE: 06/10/2022

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	At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Exit interview was conducted with Licensee Mary Henry at 11:25am. Copy of report provided. END OF REPORT PAGE 4 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4