198006711-7-20-2023-54-CC-WBIS-CTWNZF-20230720105416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006711
Report Date: 07/20/2023
Date Signed: 07/20/2023 10:54:31 AM

Document Has Been Signed on 07/20/2023 10:54 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: 11	DATE:	07/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Lilian Henriquez		TIME COMPLETED:	11:05 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 and two cleared assistants were providing care for 11 children ( three school age, five preschool, three infants). There are currently 12 children enrolled. At Approximately 8:50am 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 8:00am and 9:30am LPA observed age appropriate toys and equipment inside the home and in the front yard. LPA informed 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, small dog and two caged birds that are accessible to children. LPA informed 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: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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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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: 07/20/2023

NARRATIVE

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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 and must be replaced or serviced by 9/29/2023. 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, 2023. LPA observed the Licensee/staff has the current Mandated Reporter training which expires July 30, 2023. LPA observed the Licensee and staff has immunization records regarding measles, pertussis and tuberculosis on file.

At 9:25am LPA reviewed five 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, Immunization records and LIC 9227 Safe sleep. LPA also observed Safe Sleep logs for children under two years old.

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. The department does not recommend trampolines. 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: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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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: 07/20/2023

NARRATIVE

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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: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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