198004787-3-17-2025-33-CC-CTUA-DEURU2-20250317131910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004787
Report Date: 03/17/2025
Date Signed: 03/17/2025 01:19:41 PM

Document Has Been Signed on 03/17/2025 01:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	HENRY FAMILY CHILD CARE HOME		FACILITY NUMBER:	198004787
ADMINISTRATOR/ DIRECTOR:	HENRY, MARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 593-2672
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 9	DATE:	03/17/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Mary Henry		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

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 3/17/2025 at 9:05 am, Licensing Program Analysts (LPAs), Carolyn Tuba and Diana Ortiz conducted an unannounced required inspection visit for the above facility. Covid risk assessment was conducted. LPAs met with Licensee, Mary Henry. LPAs were guided on a tour of the inside and the outside of the home and obtained a census of 9 children in care during the visit with an assistant. LPAs entered the home through the front door. There is also a ringer available that was not currently working. The facility is a large family child care home. A total of 11 children are currently enrolled at this time. Facility roster was available. LPAs provided an Entrance Checklist form and printed new documents for the parent board that were outdated, Emergency Disaster Plan (LIC 610A) and Earthquake Preparedness Checklist (LIC 9148). LPAs observed the 15-minute sleep log was available and requires to be conducted for children under 2 years old and Infant Safe Sleep was discussed and the Individual Infant Sleeping Plan (LIC 9227) for children under 12 months of age was printed for future use. Family members residing in the home are 2 adults (criminal record clearance on file). Licensee disclosed that the additional adult/individual who was not present during the visit is someone who turned 18 years old today on 3/17/2025. The adult will be getting the fingerprint clearance completed today and Licensee will provide a copy of the receipt and TB test (tuberculous). There are no minor children living in the home at this time. This is a single-story individual home and consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, laundry room, living room, enclosed patio converted into daycare room, garage, dog run, a back yard and a front area. LPAs observed 2 bigger poodle breeds that are kept either in the back yard, dog run or are around the page 1 of 4

Katrina Chicote	TELEPHONE: (323) 984-3417
Carolyn Tuba	TELEPHONE: (323) 981-3350
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

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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Document Has Been Signed on 03/17/2025 01:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102425(a)(3)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above where LPA observed that mattresses for 3 cribs did not appear to be firm and was too soft which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/24/2025
	Plan of Correction
1 2 3 4	Licensee will be ordering 3 mattresses to replace the existing ones.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Katrina Chicote	TELEPHONE: (323) 984-3417
Carolyn Tuba	TELEPHONE: (323) 981-3350
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
	VISIT DATE: 03/17/2025

NARRATIVE

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children at times. LPAs observed that the dogs were friendly and had a calm disposition. Licensee states that the dogs have their current immunizations.

Areas accessible to children were inspected as follows: Far back bedroom (used as an infant sleeping area), enclosed patio converted into daycare room, bathroom and back yard.

Areas off limits include as follows: Kitchen, dining room, living room, Two bedrooms, bathroom inside master bedroom, laundry room, garage and front area.

LPAs observed that the restroom is in the hallway and children are required to walk through the kitchen, dining and living room area to access the restroom however Licensee states that children are taken as needed and supervised. LPAs did inspect the living room, dining area and kitchen to make sure there is nothing accessible that could pose a danger to the children in care. LPAs observed a fireplace has a glass door that is kept locked with a child proof safety latch.

Per Licensee, operating hours are from Monday-Friday 6:00 am – 6:00 pm will not exceed 24-hour care at any time and cares for children ages birth – 6 years of age.

Licensee states that she is part of a food program and provides the following meals: Breakfast, Lunch and AM/PM snack. Parents have a choice to either provide baby food or facility will also provide, and formula is provided the parent. LPAs advised the Licensee any baby food, formula or breast milk that is provided by parents must be labeled with child’s name with the date and stored appropriately.

Licensee states there are no firearms stored in the home. The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service. LPAs verified the phone number and email address, which were found to be correct. Fire and safety drills must be performed every 6 months and documented for review by the Department. Licensee states she had last conducted an emergency drill in February 2025, but the documentation provided indicated November 2024. No one smokes at the family childcare home. Parent Board was available with all required forms; however the Licensee did not have Earthquake Preparedness Checklist (LIC 9148). Licensee will complete and post on the parent board.

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SUPERVISOR'S NAME: Katrina Chicote	TELEPHONE: (323) 984-3417
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
	VISIT DATE: 03/17/2025

NARRATIVE

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In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training EMSA approved, Immunization's (TDAP, MMR, TB, Influenza (or a waiver for the influenza may be in writing), mandated reporter training and a valid criminal record clearance associated to the facility license.

Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection. Cleaning supplies are kept under the sink with a child proof lock. Medication/Vitamins are kept inside a kitchen cabinet and made inaccessible to children. Knives are kept on a high kitchen shelf. According to the Licensee there are no children on medication at this time.

LPA observed the required 2:A-10:B-C fire extinguisher, and was last purchased April 2024. The Licensee will be purchasing a new one and will save the receipt as proof. State Fire Marshall standards, state that fire extinguisher shall be purchased or serviced annually. The smoke and carbon monoxide detector were tested and operating properly during the visit.

Licensee cares for children 24 months and younger, and safe sleep was discussed and LPA advised of PIN 20-24 CCP Safe Sleep. The bedroom currently has 3 cribs and basinet. LPAs inspected the mattresses in all 3 cribs and found that they were not firm and felt soft. LPAs advised that mattresses are required to be replaced.

The licensee has completed training on preventive health & safety practices. Pediatric First Aid and CPR, which includes the EMSA, was available and Licensee’s expires 1/2026. The assistant’s CPR and 1^st Aid expired February 2025 and they have indicated they will be renewing. There are first aid supplies available, scissors, tweezers and emergency booklet was available. Both the Licensee’s and assistant’s Mandated Reporting Training Certificate expires on 1/2026. LPA advised that all persons working with children require the AB 1207 Mandated Reporting training which needs to be completed every 2 years. The following link http://www.mandatedreporterca.com/ was provided. The assistant provided proof of immunizations (TB, Tdap and a Flu waiver however the MMR (Measles, Mumps and Rubella) was not available). (Technical Violation was issued.) Licensee will provide proof of assistant’s MMR.
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SUPERVISOR'S NAME: Katrina Chicote	TELEPHONE: (323) 984-3417
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
	VISIT DATE: 03/17/2025

NARRATIVE

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Children files must be maintained and updated as needed and must be available for review by the Department. If children and staff leave the day care all records must be maintained for 3 years after leaving. LPAs observed that children’s files were complete and advised that the following documents of the LIC 700, LIC 627 and LIC 995A are required, as well as the immunizations. LIC 282 is also needed if liability insurance is not available.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA reviewed clearance list.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information
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SUPERVISOR'S NAME: Katrina Chicote	TELEPHONE: (323) 984-3417
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRY FAMILY CHILD CARE HOME	FACILITY NUMBER: 198004787
	VISIT DATE: 03/17/2025

NARRATIVE

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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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The deficiency listed on the following page were observed by the LPAs and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and report was reviewed with the Licensee, Mary Henry.
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SUPERVISOR'S NAME: Katrina Chicote	TELEPHONE: (323) 984-3417
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

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