198017825-4-5-2023-54-CC-WBIS-CQLUMD-20230405154211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017825
Report Date: 04/05/2023
Date Signed: 04/05/2023 03:42:27 PM

Document Has Been Signed on 04/05/2023 03:42 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 CARE		FACILITY NUMBER:	198017825
ADMINISTRATOR:	HENRIQUEZ, GENESIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 597-5368
CITY:	LONG BEACH, CA.	STATE: CA	ZIP CODE:	90815
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	04/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Genesis Henriquez		TIME COMPLETED:	03:50 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 Henriquez who guided LPA on a tour of the facility. LPA observed the Licensee and cleared assistant caring for nine children (four infants and five preschool). There are eleven children enrolled attending the facility on a part-time and full-time basis. The roster is current. All areas identified on the facility sketch were inspected. This is a single story home consisting of four 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. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed age appropriate toys and play equipment inside the home. LPA observed the daycare room to be free of hazards and children access to the bathroom by going through the kitchen. LPA advised Licensee to ensure that medicines, sharp objects, alcohol, cleaners and hazardous items be inaccessible in areas used by children. LPA also advised Licensee to install door knob covers on all doors that are in off limits areas. LPA observed the backyard play area appear to be free of hazards and to be surrounded by gates that are higher than five feet tall. The children use a divided area of the backyard. There is a working telephone maintained in the home. There is one small dog and one large dog pets in the facility. LPA observed detergents, cleaning compounds, medications, and other items (which can pose a danger to children) to be made inaccessible (locked in cabinets or high above ground). LPA informed Licensee that poisons must be locked with a key or combination lock. Per Licensee there are no firearms, weapons or bodies of water and LPA did not observe any on the premises. The License, Earthquake Preparedness and Parents Rights poster is posted.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: HENRIQUEZ FAMILY CHILD CARE	FACILITY NUMBER: 198017825
	VISIT DATE: 04/05/2023

NARRATIVE

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Smoke and carbon monoxide detectors near the kitchen were tested and are in operable condition. LPA observed the Licensee has the current Mandated Reporter training which expires in March 2024. LPA observed the Licensee/Staff documentation indicating immunization regarding MMR, DTAP and TB.

LPA reviewed two children's files which include documentation such as: Parent's Rights, Personal Rights, Affidavit for Liability insurance, Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care, and Immunization records. Note: Child #1 missing the LIC 9227 Infant Safe Sleep form. LPA cited technical due to communication issue last year provided Licensee a form.

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, 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. Licensee's CPR expires February 2024.

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 that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA discussed the form and explained that the LIC 9227 form that is available on CCLD website.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: HENRIQUEZ FAMILY CHILD CARE	FACILITY NUMBER: 198017825
	VISIT DATE: 04/05/2023

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The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. 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. Fire Drill conducted February 2023.

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. Licensee has the required current Mandated Reporter training.

LPA informed Licensee information regarding with Safe Sleep PIN 20-24-CCP. LPA also discussed Entrance Checklist form, Capacity and Ratio, and Items not Permitted. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

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: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

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