406215848-8-12-2021-17-CC-MKST-C5TQKA-20210812121402

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215848
Report Date: 08/12/2021
Date Signed: 08/12/2021 12:14:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	HENDERSON FAMILY CHILD CARE AKA ABACUS CHILDCARE		FACILITY NUMBER:	406215848
ADMINISTRATOR:	ANNETTE ELAINE HENDERSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 440-2559
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	14	CENSUS: 9	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Annette Henderson		TIME COMPLETED:	12:15 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 8/12/21 at 9:51am, Licensing Program Analyst (LPA) Melissa Stewart spoke with Licensee, Annette Henderson, via phone and conducted a Facility Risk Assessment. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee and Assistant were wearing face coverings. Assistant was outside with nine (9) children including three (3) infants. LPA observed the required documents posted inside the home on the wall adjacent to the front door. LPA observed age appropriate toys, play kitchen, train track, books and child sized table and chairs in the indoor activity area located in the first room of the home. Licensee reported that children also nap on mats in this room. There is a retractable safety gate at the doorway which leads to the stairs, kitchen, living room, bathroom, and one bedroom. Fireplace in the living room is screened. Detergents, cleaning compounds, medications and other items such as kitchen knives which could pose a danger to children are stored inaccessible to children. The downstairs bathroom used by children was observed to be clean and free of toxins. Licensee stated that children are always supervised when using the restroom. The downstairs bedroom and four (4) upstairs bedrooms are occasionally used for napping children. Licensee indicated that she was under the impression that infants older that 12 months could sleep on a different floor than the provider. LPA explained that according to the Infant Safe Sleep Regulation section 102425, the only regulation which applies only to infants 12 months and younger is the Individual Infant Sleeping Plan (LIC9227). Licensee stated that she understood and would not sleep infants under the age of 2 years on a different floor of the home if not supervised by a provider on the same floor. Licensee stated there are no guns or ammunition in the home. Carbon monoxide and smoke detectors were tested at 9:58am and found to be operational. LPA observed the 2 A10 BC fire extinguisher with a service date of 12/4/2020. Licensee was reminded to service or replace the fire extinguisher yearly and retain the receipt for review during inspections. Licensee completes and documents emergency drills. The most recent drill was held on 4/28/21. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HENDERSON FAMILY CHILD CARE AKA ABACUS CHILDCARE	FACILITY NUMBER: 406215848
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/03/2021 Section Cited	1 2 3 4 5 6 7	102417 Operation of a Family Child Care Home (5) All licensees shall ensure the inaccessibility of pools... Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation, one (1) of the four (4) plastic latches securing the spa cover is broken. LPA was able to lift the front, right hand side of the spa cover approximately three (3) inches with effort. Licensee did not ensure that the spa cover was completely locked. This poses a potential risk to the health and/or safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HENDERSON FAMILY CHILD CARE AKA ABACUS CHILDCARE	FACILITY NUMBER: 406215848
	VISIT DATE: 08/12/2021

NARRATIVE

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The backyard is completely fenced; LPA observed age appropriate riding toys, tunnel, sandbox, playhouse with slide and stairs. Licensee stated that children are always supervised when outside and that children under two (2) years are not permitted passed the first step of the stairs of the play structure. Licensee has one large dog and one small dog which LPA observed to be child friendly. Licensee stated that vaccines and licenses are current and on file. LPA observed that one (1) of the four (4) plastic latches securing the spa cover is broken. LPA was able to lift the front, right hand side of the spa cover approximately three (3) inches with effort.

Licensee is Pediatric CPR and first aid certified through 4/2023. Licensee has met SB 792 immunization requirement and completed Mandated Reporter Training per AB 1207 on 7/29/2020. LPA reminded Licensee that the Mandated Reporter training must be renewed every two years. Facility roster and a sample of children's records were reviewed and found complete. Licensee was reminded that it is her responsibility to know the regulations for FCCH which can be accessed on-line at www.cdss.ca.gov. Licensee reported that she receives Provider Information Notices (PINs) via email.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. 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: www.ada.gov/childqanda.htm

Type B deficiency cited today in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and Plan of Correction was developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee, Annette Henderson, whose signature on this form confirm receipt of these documents.

LPA provided Administrator a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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