<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017825
Report Date: 03/23/2022
Date Signed: 03/23/2022 04:42:12 PM

Document Has Been Signed on 03/23/2022 04:42 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:HENRIQUEZ FAMILY CHILD CAREFACILITY NUMBER:
198017825
ADMINISTRATOR:HENRIQUEZ, GENESISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 597-5368
CITY:LONG BEACH, CA.STATE: CAZIP CODE:
90815
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Genesis HenriquezTIME COMPLETED:
04:55 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
Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required 1 Year inspection. LPA met with Licensee Genesis who guided LPA on a tour of the facility. LPA observed the Licensee and cleared assistant caring for six children (four infants and two preschool). There are seven children enrolled attending the facility on a part-time and full-time basis.

All areas identified on the facility sketch were inspected. This is a single story home consisting of three bedrooms, two bathrooms, kitchen, living room, Family room, back yard, and garage. The Licensee provides care in the family room, bathroom, enclosed backyard. Areas off limits to children in parents include all bedrooms, master bathroom, kitchen, living room, part of the back yard and the garage. At 1:40pm LPA provided Licensee with Items not permitted, PIN 20-24-CCP Infant Safe and a form regarding capacity/ratio.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. At 1:45pm LPA observed four empty inclined sleepers. LPA informed Licensee that inclined sleepers are prohibited from Licensed child care facilities and must be removed. Licensee removed the sleepers to an inaccessible area. LPA observed other toys and play equipment to age appropriate. LPA observed the off limit rooms inaccessible by a baby gates in the hallway. There is was no fire place observed in the home and the garage is inaccessible. Around 2:00pm LPA observed the outdoor play area appear safe and free of hazards with the exception of an outdoor grill. LPA informed Licensee that the grill must be placed in an inaccessible area or it must be covered. LPA informed Licensee to ensure that propane tanks are stored in inaccessible areas as well. The backyard is surrounded by gates that are higher than five feet. The garage is off limits and remains inaccessible. There is a working telephone maintained in the home. LPA observed two small indoor dogs and one large outdoor dog. The dogs remain inaccessible to children. LPA observed Detergents, cleaning compounds, medications, and other items which can pose a danger to children to be inaccessible (kitchen is barricaded with baby gates and items in bathroom are high above ground). LPA informed Licensee that poisons must be locked with a key or combination lock.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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: HENRIQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198017825
VISIT DATE: 03/23/2022
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
26
27
28
29
30
31
32
 Per Licensee there are no firearms, weapons or bodies of water on the premises (and LPA did not observe any). LPA observed the License, Earthquake Preparedness form and the Parents Rights poster posted in the facility. The children's roster and Disaster drill is current (last date of drill March 23, 2022. At 3:3:00pm LPA observed the required 2A 10BC fire extinguisher's annual service is due July 1, 2022. The Licensee's Mandated Reporter training is expired in 2020 and must be renewed. The Licensee and staff have Measles and Pertussis documentation on file.

At 2:15pm LPA reviewed six children's files and observed files to be complete. The files included items such as Parent's Rights, Affidavit for Liability Insurance, Identification and Emergency, Consent for Emergency Treatment and Immunization records LPA provided Licensee with LIC 9227 Safe Sleep documents to prepare for infants under 12 months.

The following was discussed: Individuals who are 18 years of age or older 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 a 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. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

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.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
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: HENRIQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198017825
VISIT DATE: 03/23/2022
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
26
27
28
29
30
31
32
LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. 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). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com.

LPA provided Licensee with Safe Sleep PIN 20-24-CCP also discussed Covid Self Assessment and Covid safety according to the Los Angeles County Health Department.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Henriquez.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/23/2022 04:42 PM - It Cannot Be Edited


Created By: Warren Birks On 03/23/2022 at 04:13 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HENRIQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198017825

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2022

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
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above: Licensee's Mandated reporter expired which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/06/2022
Plan of Correction
1
2
3
4
Licensee will renew Mandated Reporter.
Type B
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above: LPA observed empty inclined sleepers in the daycare area and a grill in the backyard play area which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/23/2022
Plan of Correction
1
2
3
4
Licensee indicated she will remove the sleepers and bbq grill.
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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022


LIC809 (FAS) - (06/04)
Page: 4 of 4