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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845313
Report Date: 07/15/2026
Date Signed: 07/15/2026 05:12:09 PM

Document Has Been Signed on 07/15/2026 05:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:HENRY FAMILY CHILD CAREFACILITY NUMBER:
334845313
ADMINISTRATOR/
DIRECTOR:		HENRY, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 565-3873
CITY:RIVERSIDESTATE: CAZIP CODE:
92501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 13DATE:
07/15/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Licensee Yolanda HenryTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On date and time listed above, Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility to conduct an annual inspection and was granted entry by Licensee Yolanda Henry. LPA toured the facility, reviewed records, and observed and/or discussed the following: Also present were two resident adult residents. One adult resident acting as a assistant. The licensee stated they are providing overnight care for children. The licensee updated the days and hours of operation on the LIC279 Application form to reflect the changes.

Days and hours of operation are Monday- Sunday, 12:00 AM to 11:59 PM
OFF-LIMIT AREAS INCLUDE: Bedroom 1 and Garage.

The inspection consisted of reviews of the CARE tool domains. The inspection found the facility to be in compliance except as noted on the LIC809D. Licensee is present and operating within the licensed capacity with appropriate supervision and ratio with 13 children in care.
A working telephone is verified
A fully charged fire extinguisher (2A:10BC) was observed and tagged by the fire department and needle in the green. A smoke detector and carbon monoxide detector were present and tested by the licensee during this inspection on 07/15/2026.
The LPA observed an artificial fireplace which is properly screened.
No stairs, this is a single-story home
Facility is clean, orderly and has adequate heating and ventilation.
NAME OF LICENSING PROGRAM MANAGER: Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HENRY FAMILY CHILD CARE
FACILITY NUMBER: 334845313
VISIT DATE: 07/15/2026
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All hazardous items are NOT inaccessible to children. The LPA observed sharp kitchen cooking scissors stored in the sink and in dishwasher; The LPA observed storage of hygiene products, bleach wipes, air fresheners, vapor rub unlocked in cabinets and open shelving; shaving razors in the medicine cabinet and in shower, bleach wipes under restroom vanity, accessible to children. Storage of poisons/toxins are NOT locked. The LPA observed a can of raid bug killer under the kitchen sink, 2 cans of Off bug spray and Lysol spray accessible to children in outdoor play area.
Facility has safe, age-appropriate toys for indoor and outdoor activities. Outdoor play area is fenced.
Verification of control of property on file by rental agreement. Property owner/landlord notification and consent on file
The following postings are visible: License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148); Parent’s Rights Poster (PUB393); Personal Rights; Child Car Seat Law and facility sketch.
Pediatric CPR and First Aid Card expires on: 02/22/2028
Health & Safety Certificate - completed on 11/16/2003 (No Nutrition); 08/29/2018 Nutrition (No lead)
Mandated reporter: Child Care Expired: 07/08/2025
Fire clearance: 07/28/2023
Documentation of fire & earthquake drills completed on 05/09/2026 at 10:00 AM with 11 children in care.
Children/Infant records are complete: 2 Infant children under age 2 missing Sleep logs, 1 child missing Individual Sleep Plan, 1 child missing proof of immunization record, 1 child missing LIC627 Consent for Emergency Medical Treatment.
Employee records are NOT complete: AB1207 exp. 08/25/2025,

Guns or weapons are not present as stated by the Licensee. The Licensee Yolanda Henry understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.

There are no bodies of water during this visit Licensee understands all bodies of water must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of water bodies.
NAME OF LICENSING PROGRAM MANAGER: Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HENRY FAMILY CHILD CARE
FACILITY NUMBER: 334845313
VISIT DATE: 07/15/2026
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Additionally, the following was reviewed with Licensee.
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.
-AB2960 – This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive childcare and development services online portal for families and providers by June 30, 2022.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
-Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
-Duty Officer availability: Mon. – Fri. at 1-844-LET-US-NO (1-844-538-8766)
-Access to forms & Regulations online at www.ccld.ca.gov
-Licensee is responsible to know the regulations for anyone providing care
-Failure to meet the posting requirements shall result in an immediate civil penalty

To receive important licensed -related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication

Licensee Yolanda Henry was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
NAME OF LICENSING PROGRAM MANAGER: Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HENRY FAMILY CHILD CARE
FACILITY NUMBER: 334845313
VISIT DATE: 07/15/2026
NARRATIVE
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Licensee Yolanda Henry was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

LPA discussed the safe sleep regulations with Licensee Yolanda Henry and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.



LPA also informed Licensee Yolanda Henry of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA Susan Brewer informed Licensee Yolanda Henry that this report dated 07/15/2026 documents 1 Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.
NAME OF LICENSING PROGRAM MANAGER: Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HENRY FAMILY CHILD CARE
FACILITY NUMBER: 334845313
VISIT DATE: 07/15/2026
NARRATIVE
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Also, LPA Susan Brewer informed the Licensee Yolanda Henry to provide a copy of this licensing report dated (insert visit date) that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

During the exit interview, the Licensee Yolanda Henry, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Deficiencies were cited this visit for a Type A and 4 Type B violation.

Civil Penalties were not cited during this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, the report was reviewed and a copy of the report was left with Licensee Yolanda Henry.
NAME OF LICENSING PROGRAM MANAGER: Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 6 of 12
Document Has Been Signed on 07/15/2026 05:12 PM - It Cannot Be Edited


Created By: Susan Brewer On 07/15/2026 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HENRY FAMILY CHILD CARE
FACILITY NUMBER: 334845313

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observations) the licensee did not comply with the section cited above in the LPA observed cooking scissors, household cleaners, & Raid bug killer accessible in the kitchen, hygiene products, bleach wipes, air fresheners, vapor rub unlocked in cabinets; shaving razors, bleach wipes accessible in the restroom; Off bug spray & Lysol spray accessible to children in outdoor play area, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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The licensee agrees to ensure the home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children; Ensure the items are stored where they are inaccessible to children. Storage areas for poisons, firearms, other dangerous weapons are locked & submit proof by photo, with a statement of understanding the regulation cited.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/15/2026 05:12 PM - It Cannot Be Edited


Created By: Susan Brewer On 07/15/2026 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HENRY FAMILY CHILD CARE
FACILITY NUMBER: 334845313

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee and their assistan did not renew the Mandated Reported Training withing 2 years of initial training as required, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2026
Plan of Correction
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The licensee agrees to ensure a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training; and submit proof of certificate by email or mail.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in one subject child in care was missing proof of immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2026
Plan of Correction
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The licensee agrees to ensure each daycare child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, is maintained for child when they are enrolled.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/15/2026 05:12 PM - It Cannot Be Edited


Created By: Susan Brewer On 07/15/2026 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HENRY FAMILY CHILD CARE
FACILITY NUMBER: 334845313

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof of the LIC627 Consent for Medical Treatment for a subject child during a review of children's records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2026
Plan of Correction
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2
3
4
The licensee agrees to ensure an emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care, and submit proof of the LIC627 for a subject child by fax, mail or email.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in The licensee was unable to provide proof of Infant Sleep Logs with 15 minute checks and sleep status for two infants in care, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2026
Plan of Correction
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2
3
4
The licensee agrees to submit proof of Sleep Logs for Infants enrolled ages 0-24 months, to include the time of each 15-minute checks, labored breathing, signs of distress which but is not limited to flushed skin color, increase in body temperature and restlessness; and position of sleep while in care. In addition the licensee agrees to submit proof of sleep logs to the department by fax, mail or email.


This requirement is not met as evidenced by:
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2026


LIC809 (FAS) - (06/04)
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