198006711-9-27-2022-54-CC-WBIS-CJNPR3-20220927113206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006711
Report Date: 09/27/2022
Date Signed: 09/27/2022 11:32:45 AM

Document Has Been Signed on 09/27/2022 11:32 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HENRIQUEZ FAMILY DAY CARE		FACILITY NUMBER:	198006711
ADMINISTRATOR:	HENRIQUEZ,LILIAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 594-8651
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Lillian Henriquez		TIME COMPLETED:	11:45 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) Warren Birks conducted an unannounced Required - 1 Year inspection. LPA met with Licensee Lillian Hernandez who guided LPA on a tour of the facility. Upon arrival, LPA observed the Licensee was providing care for five children (two preschool, three infants). LPA also observed two cleared assistants during the visit. There are currently 10 children enrolled. At Approximately 9:00am LPA conducted an inspection of all areas of the facility sketch. This is a one story home which consists three bedrooms and two bathrooms. Areas used by the children include the living room, family room, converted garage (no eating or sleeping), one restroom, and front yard. Licensee indicated that the backyard is not used for daycare at this time. LPA informed Licensee to ensure that the children have visual supervision in the front yard as the fencing is lower (approximately 3 feet. Per Licensee, areas off limits areas to children and parents include: backyard, three bedrooms, and one bathroom. LPA informed Licensee to contact the department if she wants to use other areas of the home and make sure hazards are inaccessible. Areas accessible to children were inspected to ensure they are clean and orderly with ventilation and heating for the safety of the children. Between 9:00am and 9:30am LPA observed age appropriate toys and equipment inside the home and in the front yard. LPA advised Licensee to keep all hazardous items inaccessible from children. The backyard is surrounded by fencing approximately 5 feet high however it is not in use at the time. There is a working phone maintained in the home. LPA observed one medium sized dog and two caged birds that are accessible to children. LPA advised Licensee to provide extra care and supervision when children play with pets (as pets are unpredictable). LPA observed detergents, cleaning compounds, medications, and other items which can pose a danger to children to be inaccessible (in locked kitchen and bathroom cabinets). LPA informed Licensee that poisons must be locked with a key or combination lock.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRIQUEZ FAMILY DAY CARE	FACILITY NUMBER: 198006711
	VISIT DATE: 09/27/2022

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

Per Licensee there are no firearms, weapons or bodies of water and LPA did not observe any on the premises. The License, Parents Rights Poster, and Earthquake Preparedness was posted. The valve on the required 2A 10BC fire extinguisher indicates fully charged however service was due in July 2022. Smoke and carbon monoxide detectors in the dining room were tested and are in operable condition. The children's roster and the Disaster drill is current (last date of drill June, 2022. LPA observed the Licensee/staff has the current Mandated Reporter training which expires July 2023. LPA observed the Licensee also has documentation indicating immunization regarding measles, pertussis and tuberculosis on file.

LPA reviewed six children's files which include the documentation such as: Parent's Rights, Personal, Affidavit for Liability insurance, Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care and Immunization records. at 10:00am LPA observed files for child #1,2 and 5 missing form LIC 9227 Safe sleep. The Licensee indicated she will start using those forms.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present. Licensee's CPR expires September March 2024

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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRIQUEZ FAMILY DAY CARE	FACILITY NUMBER: 198006711
	VISIT DATE: 09/27/2022

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

LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA provided a form and explained that the form is available on CCLD website. Licensee did not implement and will need to implement files.

The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

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 which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com.

LPA informed Licensee and assistant regarding with Safe Sleep PIN 20-24-CCP LPA also discussed Entrance Checklist form, Capacity and Ratio, and Items not Permitted. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Lillian Henriquez.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 09/27/2022 11:32 AM - It Cannot Be Edited

Created By: Warren Birks On 09/27/2022 at 10:44 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRIQUEZ FAMILY DAY CARE	FACILITY NUMBER: 198006711
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. 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: LPA observed fire extinguisher was not serviced annually which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2022
	Plan of Correction
1 2 3 4	Licensee indicated she will service fire extiguisher.

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above: Licensee did not complete LIC 9227 forms for child 6 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2022
	Plan of Correction
1 2 3 4	Licensee indicated she will

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:

Karen Chambers

LICENSING EVALUATOR NAME:

Warren Birks

LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4