198019922-11-20-2025-54-CC-ACAN-DNLV25-20251120150232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019922
Report Date: 11/20/2025
Date Signed: 11/20/2025 03:02:53 PM

Document Has Been Signed on 11/20/2025 03:02 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HENDERSON FAMILY CHILD CARE		FACILITY NUMBER:	198019922
ADMINISTRATOR/ DIRECTOR:	ROBIN HENDERSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 756-3137
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	11/20/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:32 PM
MET WITH:	ROBIN HENDERSON / LICENSEE		TIME VISIT/ INSPECTION COMPLETED:	03:12 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) Ashley Calderon conducted an unannounced random / annual inspection at the above facility. LPA met with Licensee Robin Henderson who allowed LPA entry to the facility. LPA disclosed purpose of today's inspection. Upon entrance, LPA observed 2 children. Per Licensee, currently no infants in care are enrolled. Hours of operation are Mon-Thursday 12AM-11:59PM/ Friday 12:00PM - 6am, closed Saturday after 6am and Sundays. Facility capacity is in compliance for a Large Family Child Care Home -Capacity 14. This is a two level home with four bedrooms, three bathrooms, kitchen, dining area, living area, patio, day care room (garage), backyard, side and front yard. The children use: the bathroom in the hallway near the daycare room, living room, and backyard. Per licensee, areas off limits to children and parents include: upstairs and bedrooms located downstairs, front/side yards, dining area, and kitchen. The following was observed and reviewed during this inspection: Tour was conducted alongside Licensee R.Henderson. There was a visitor present that was in the off limit bedroom with Licensees mother who resides in the home. Visitor does not interact with children in care. Kitchen was inspected, Licensee provides food for the children. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. Living room was observed to have a fire place with a barricaded screen and a baby gate a the bottom of the stairway. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HENDERSON FAMILY CHILD CARE	FACILITY NUMBER: 198019922
	VISIT DATE: 11/20/2025

NARRATIVE

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LPA reviewed required posted documentation's in the living room for Facility License, Notification of Parent Rights and Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 8/22/25. LPA did not test carbon monoxide and smoke alarm due to napping children. Fire extinguisher was serviced and dated May 2025 . Facility provides transportation and facility cares for after school children.

Children who are observed ill will be placed in an isolation area; waiting to be picked up by Authorized Guardian will be in a room that is not occupied by the children who aren't ill; either in the living room or (day care) garage.

Children were observed napping in the living room.There is central heating and ventilation (A/C) for the children in care. Per Licensee, no children currently on medication. LPA informed Licensee when infants are enrolled and present, must use a play yard or a crib with a firm mattress and fitted sheets with no objects hanging above crib, on crib and no items inside the play yard/ crib when children are sleeping. Home has age appropriate toys, materials and equipment for the children in care. Rooms that are inaccessible to children in care have door knobs that are kept locked.

Backyard was observed, there is a pond that is covered, has no water and not operable. Children had age appropriate outdoor equipment for play.

Staff and children records were reviewed. 5 children records were reviewed. Files had appropriate documentation in place. Home does not carry Liability Insurance and children files were reviewed to have LIC282 Affidavit Regarding Liability Insurance. LPA Calderon gave consultation on Additional Children In Care form - LIC9150. Licensees Mandated Reporter training expires on 9/6/2026 and consultation was given do to the required hours. Licensee first aid and cpr expires on 7/2026. Staff Assistant is qualified to care for children; LPA informed Licensee must be present 80% of hours of operation.

Declaration was given regarding a individual who is not fingerprinted cleared and not eligible to be at the home during hours of operations. LPA Calderon informed Licensee to update the facility hours of operation on LIC279 and send Application- Update to the department via mailing address.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HENDERSON FAMILY CHILD CARE	FACILITY NUMBER: 198019922
	VISIT DATE: 11/20/2025

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Licensee 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.
LPA discussed the safe sleep regulations with licensee 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 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.
This facility does not provide Incidental Medical Services – IMS at this time. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the Licensee Robin Henderson, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
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.

Per California Code of Regulation, Title 22, facility was given 0 deficiencies during today's visit and was found to be in compliance.
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A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Robin Henderson.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

LIC809 (FAS) - (06/04)

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