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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019922
Report Date: 02/12/2020
Date Signed: 02/12/2020 01:21:09 PM

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:HENDERSON FAMILY CHILD CAREFACILITY NUMBER:
198019922
ADMINISTRATOR:ROBIN HENDERSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 756-3137
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 1DATE:
02/12/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Robin HendersonTIME COMPLETED:
01:40 PM
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Licensing Program Analysts (LPA) Susann Sanchez and Alanna Gontarek conducted an unannounced random inspection to the above facility. LPAs met with Robin Henderson, Licensee who guided analysts on a tour of the facility. The licensee states that she currently has 13 children enrolled. There was one child present during inspection. Hours of operation are Monday to Sunday from 6:00 AM to 11:59 PM.

This is a two level home with four bedrooms, three bathrooms, kitchen, dining area, living area, covered patio, day care room along with open backyard, side yard and front yard. Part of the front yard is fenced. The front yard and backyard is fenced. The children use: the bathroom in the hallway, living room, day care room, and dining room areas. Per licensee, areas off limits to children and parents include: upstairs and both bedrooms located downstairs. The back yard and front is also off-limits. The licensee provides food for children in care: breakfast, lunch, and P.M. snacks.

The licensee states that 5 adults and 0 children currently live in the home. 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 and/or firearms. LPAs observed a covered water fountain in the backyard. LPAs observed no water inside fountain. LPAs obtained a declaration and it will be on file regarding bodies of water.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). The following was observed and reviewed during this inspection.

PHYSICAL PLANT
Detergents, cleaning compounds, and other items which could pose a danger are inaccessible to children and are kept in a closet in the day care room, Medications are kept in a off- limit bedroom room. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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 5
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: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 198019922
VISIT DATE: 02/12/2020
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Fireplaces and open face heaters are inaccessible to prevent access by children. Fireplace is locked and inaccessible. The valve on the required 2A 10BC fire extinguisher indicates fully charged, however there is no proof of purchase or service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. At this time, Licensee has no proof of Fire Drill or Earthquake Log. 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 05/18/20. There are first aid supplies available.

The home is observed to be clean and orderly. There is heating and ventilation for safety and comfort. Where children are less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. There are toys available for children in the day care room.

The licensee states that there is a land line on the premises and the licensee states that a cell phone is used for the daycare, and stays at the facility during operating hours.

The outdoor play area was observed to be fenced. Per licensee, at this time, back yard is off-limits and is working on getting astro turf installed. Licensee states that she will contact the department when construction begins in the backyard. At this time, children are walking to Mills Park (1 block away) for outdoor playtime.

The licensee is observed to be operating within the license capacity limitations. 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.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 198019922
VISIT DATE: 02/12/2020
NARRATIVE
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H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee does/does not have proof of immunization against influenza, pertussis, and measles.

LPAs issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

PETS: There are no pets on the premises.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster, Car Seat Law, and the Facility License are observed to be posted in the day care room.
PROHIBITED: 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 LICENSED FAMILY CHILD CARE HOME. **DO NOT SLEEP INFANTS IN CAR SEATS.**

Infant Care: Licensee states that she is not currently caring for infants. LPAs advised Licensee that is she cares for infants in the future, to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. 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. LPAs consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hot line information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.

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.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 198019922
VISIT DATE: 02/12/2020
NARRATIVE
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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/ Licensee has proof of Mandated Reporter Training, completed on 1/31/2020

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). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.



Based on the LPAs observations and records review, the following deficiencies listed on the attached LIC 809d (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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, Robin Henderson. Failure to maintain posting as required will result in a civil penalty of $100.00. Appeal rights were given and explained.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 198019922
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/19/2020
Section Cited

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Operation of a Family Child Care Home
Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.

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This requirement is not met as evidenced by LPAs observed no proof of Disaster Drill Log. This poses a potential risk to the health and safety of childern in care.
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Type B
02/26/2020
Section Cited

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Operation of a Family Child Care Home
The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement is not met as evidenced by LPAs observed no proof of fire extinguisher service tag or purchase receipt.
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This poses a potential risk to the health and safety of childern in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5