198400733-5-12-2021-54-CC-MAYA-C2XML3-20210512094140

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400733
Report Date: 04/20/2021
Date Signed: 05/12/2021 09:41:51 AM

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:	HENRY FAMILY CHILD CARE		FACILITY NUMBER:	198400733
ADMINISTRATOR:	HENRY, BARBARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(424) 223-0888
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY:	14	CENSUS: 0	DATE:	04/20/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Applicant, Barbara Henry		TIME COMPLETED:	04:00 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 April 20, 2021 at 2:00 PM, Licensing Program Analyst (LPA) Monique Ayala conducted a Prelicensing tele-inspection via Zoom Meeting with Applicant, Barbara Henry. The inspection was conducted via Zoom Meeting due to the Coronavirus Disease 2019 (COVID-19) pandemic. The Applicant is requesting a Location Change with a Capacity Change for a Large Family Day Care Home (up to 14 children). A fire clearance for the requested capacity was granted on March 4, 2021. At the time of the inspection, individuals residing in the home was discussed and assessed. The operating hours will be 7 days a week, 23 hours per day. The applicant is applying to care for children ages, newborn to 12 years old. All areas identified on the facility sketch were virtually inspected. This facility is a two story home that consists of 2 bedrooms, 2 bathrooms, living room, den, kitchen, garage and fenced backyard. Areas that are accessible to children include: living room, kitchen, den, downstairs bathroom, and fenced backyard. Per applicant, the children will utilize the fenced backyard for outdoor activity. Areas off limits to children include: 2 bedrooms located upstairs, 1 bathroom located upstairs, and garage. LPA observed a child safety gate installed at the end of the stairway, making the upstairs area inaccessible to children in care. LPA also observed a child safety knob installed on the garage door, making the garage inaccessible to children in care. The Applicant was advised that off-limit areas must be made inaccessible during operating hours.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021

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: HENRY FAMILY CHILD CARE	FACILITY NUMBER: 198400733
	VISIT DATE: 04/20/2021

NARRATIVE

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Areas used by children were inspected for safety, comfort, cleanliness and telephone service. The home does not have a fire place or any wall heaters. The home has central heating that is operable. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. Applicant was advised that if any poisons are purchased, it is required to be locked with a key or combination lock.

Per Applicant, the home does not have any pets, firearms, weapons, or bodies of water. LPA observed age appropriate toys and napping equipment. LPA observed electrical outlet covers throughout the facility. LPA observed the required fire extinguisher (2A-10BC) that is fully charged. Smoke and carbon monoxide detectors were tested by the Applicant and are operable. First Aid kit is available and located in the living room. The Applicant has a no-touch thermometer readily available. The Applicant was advised that if food is brought from the children’s home, all containers must be labeled with the child’s name and properly stored or refrigerated.

The Applicant has proof of Pediatric First Aid/CPR certification (expires 01/2023). Applicant has proof of immunization against pertussis. Applicant completed the Mandated Reporter training (AB 1207) on 11/21/2019. Applicant was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

During the tele-inspection, LPA discussed Forms/Records to Keep in Your Family Child Care Home (LIC 311D). LPA also discussed reference material on the California Car Seat Law Changes (effective January 1, 2017), Effects of Lead Exposure, Shaken Baby Syndrome, Sudden Infant Death Syndrome (SIDS), and recently approved safe sleep regulations in effect (Provider Information Notice (PIN) 20-22-CCP, dated 09/15/2020).

LPA observed the following forms posted in the facility: Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parents’ Rights Poster (PUB 394), and COVID-19 related posters.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021

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: HENRY FAMILY CHILD CARE	FACILITY NUMBER: 198400733
	VISIT DATE: 04/20/2021

NARRATIVE

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Facility Forms/Records to keep in your home:
1. Personnel Records as required in Title 22, Division 12, Chapter 3, Section 102416.1, including but not limited to, proof of current pediatric first aid, CPR, preventative health practices certificate, mandated reporter training certificate and criminal record information.
2. Unusual Incident/Injury Report (LIC 624B).
3. Child Care Facility Roster (LIC 9040).
4. Notice of Employee Rights (LIC 9052).
5. Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108).
6. Property Owner/Landlord Consent Form (LIC 9149).
7. Property Owner/Landlord Notification Form (LIC 9151).
8. A copy of your deed or lease/rental agreement.
9. Affidavit Regarding Liability Insurance (LIC 282).

The following was also discussed with the Applicant:
1. Individuals who are 18 years of age or older and 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 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.
2. 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 adult/infant CPR and Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
3. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.
4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.
5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021

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: HENRY FAMILY CHILD CARE	FACILITY NUMBER: 198400733
	VISIT DATE: 04/20/2021

NARRATIVE

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8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.
9. Smoking is prohibited in the family child care home.
10. Children and staff records must be maintained and updated as needed and be available for review by the Department.
11. Dog(s) and/or pets are recommended to be isolated from children in care.
12. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category is not permitted in the facility.

On April 19, 2021, the Applicant submitted the completed Child Care Program COVID-19 Self-Assessment. During the tele-inspection, LPA reviewed the implementations noted on the guide and discussed plans to ensure that the applicant will meet COVID-19 guidance for a child care setting.

LPA observed that the Applicant has hand sanitizer, cleaning solutions, and gloves readily available. Applicant was advised that children may use hand sanitizer but only under adult supervision and hand sanitizer must be kept out of children's reach.

The Applicant will require all staff and children over the age of 2 to wear cloth face coverings. Applicant plans on training staff and communicating with families on the following: enhanced sanitation practices, physical distancing guidelines, use of face coverings, screening practices, COVID-19 specific exclusion criteria, and arrangements for back up child care should a family member or their child exhibit COVID-19 symptoms or test positive.

Applicant plans on introducing outdoor air as much as possible. Applicant plans to have all personal items labeled and kept in a separate space to ensure that personal items are separate from others. Applicant stated that personal toys and blankets are washed daily by the provider.

Per Applicant, the parents/caregivers will sign their children in and out inside the home by the front entrance. Applicant will have sanitized pens readily available for parent use. Upon arrival, the Applicant plans on conducting a health screening of the children by taking the child's temperature and asking the child's parent/caregiver questions regarding any confirmed cases of COVID-19, COVID-19 exposure or COVID-19 symptoms.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021

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: HENRY FAMILY CHILD CARE	FACILITY NUMBER: 198400733
	VISIT DATE: 04/20/2021

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Applicant will disinfect and sanitize high touched areas after each use. Applicant plans on teaching the children to avoid contact with one's eyes, nose and mouth, and use tissue to wipe their nose and to cough or sneeze inside their elbow. The Applicant plans on modeling and practicing hand washing before and after eating, after coughing or sneezing, after playing outside, and after using the restroom. When a child becomes ill, the Applicant will have the child separated from other children until the child is picked up by their parent or emergency contact person.

The Applicant was advised to report any possible exposures and/or positive cases of COVID-19 to the Regional Office. The Applicant was also advised that staff and families must be notified immediately of any possible cases of COVID-19 while maintaining confidentiality.

Incidental Medical Services (IMS) policy was also 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 Americans with Disabilities Act (ADA) was provided: U.S. 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 Applicant on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at www.ccld.ca.gov.

The following documents are required for further processing:

Emergency Disaster Plan (LIC 610A) with two temporary relocation sites listed (section 4).
Health & Safety Training Certificate, including Nutrition and Lead components.
Immunization record: Measles (MMR) for Applicant

The documents noted above are due by May 5th. A final review of the application will be conducted by the Department. Once licensed, the provider is required to adhere to the terms and limitations stated on the license.

An exit interview was conducted and a copy of this report will be issued via email. LPA requested the report to be signed and returned to the Monterey Park South West Child Care Regional Office.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021

LIC809 (FAS) - (06/04)

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