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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019922
Report Date: 08/05/2021
Date Signed: 08/05/2021 11:21:12 AM

COMPREHENSIVE INSPECTION
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: 4DATE:
08/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Robin Henderson, LicenseeTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced random inspection to the above facility. LPAs met with Robin Henderson, Licensee who guided analysts on a tour of the facility at 9:43am The licensee states that she currently has 8 children enrolled. There were three children and one infant 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, patio, day care room, backyard, side and front yard. The children use: the bathroom in the daycare room, daycare, living room, and backyard. Per licensee, areas off limits to children and parents include: upstairs and bedrooms located downstairs, front yard, dining area, or kitchen. The licensee provides food for children in care: breakfast, lunch, and P.M. snacks.

The licensee states that 4 adults 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. LPA observed a covered water fountain in the backyard. A declaration was collected on 02/12/20 and is on file regarding bodies of water. Per Licensee, there is never water in the fountain and children are supervised at all times.

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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 198019922
VISIT DATE: 08/05/2021
NARRATIVE
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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 it has not been serviced since 02/18/2020. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Carbon monoxide detector were tested and are operable. Licensee tested smoke detector and it was not working. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill conducted was on 02/12/21. The licensee's Pediatric First Aid and CPR expired on 05/18/20 and did not have proof of a current CPR & First Aid card. There are first aid supplies available.

The home is observed to be clean and orderly. There is heating and ventilation for safety and comfort. There are toys available for children in the day care room.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, children play in the backyard for outdoor play. Children also walk 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.

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.

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.**
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 198019922
VISIT DATE: 08/05/2021
NARRATIVE
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Infant Care: Licensee states that she is currently caring for infants. 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. The licensee stated the following as a supervision plan for infants: Licensee states that infants sleep in the living room. LPA provided the licensee with a copy of the Child Care Pro. LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. PIN 20-24 was given and explained. LPA also provided a copy of LIC 9227 and a Infant Sleeping Log.
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 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, and expires on 01/31/2022.

LPA discussed Department of Public Health, Early Care and Education Guidance COVID-19 recommendations. Per Licensee she is still following COVID19 guidelines and uses best practice.

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.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 198019922
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2021
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.This poses a potential risk to the health and safety of childern in care.
Type B
09/06/2021
Section Cited

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Personnel Requirements- The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement was not met as evidenced by file review. Licensee's CPR and First aid
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certification expired on 11/2018. This is a potential risk to the health and safety of the children in care.
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Type B
09/03/2021
Section Cited

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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 Marshal.The requirement is not met as evidenced by: Smoke detector was not working during tour This is a potential risk to children in care.
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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4