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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018911
Report Date: 09/15/2023
Date Signed: 09/15/2023 01:03:18 PM

Document Has Been Signed on 09/15/2023 01:03 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:FIELDS-BENJAMIN FAMILY CHILD CAREFACILITY NUMBER:
198018911
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Shannon Fields-Benjamin, LicenseeTIME COMPLETED:
01:25 PM
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Licensing Program Analysts (LPA) Susann Sanchez conducted an unannounced annual required inspection at the above facility at 10:20AM. LPA met with Shannon Fields-Benjamin, Licensee who guided analysts on a tour of the facility. There were 2 children and 1 infant present with the licensee, present when LPA arrived. Facility capacity is in compliance for a Small Family Child Care Home. Hours of operation are Mon-Fri 6:00 AM - 6:00PM. Licensee is available 24/7 if needed. Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

This is a two story home which consists of 3 bedrooms, 2 restrooms, kitchen, family room, living room, backyard (fenced), garage, and front yard. The following areas are used for day-care: Family room, 1 bathroom, living room, and kitchen. Off limit areas include: , All of upstairs (3 bedrooms and 1 bathroom), backyard, front yard, and garage.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:



LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form (given by LPA during inspection). Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan (completed during inspection).

At 10:50am, LPA asked for a to see the disaster drill log, but did not have it. LPA provided a copy to use. Type B was cited.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911
VISIT DATE: 09/15/2023
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At 10:30am, during tour, LPA observed an infant sitting on a saucer/walker chair. LPA told Licensee that walkers or anything in that category are not allowed. Licensee stated that she understood but did not remove the child for approximately 20 minutes. LPA also observed a bouncer. Photo was taken and type B was cited. At 11:42am, Licensee removed the saucer/walker.

Smoke and carbon monoxide detectors were tested and are operable. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds and medication are stored in the kitchen , inaccessible to children by latches and high cabinets. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Currently licensee has 1 infant enroll and 1 infant was present during inspection. Per Licensee, infant sleeps on a mat. Napping equipment does not block entrances or exits. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yards. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP.

Currently, children do not play in the backyard. Children play in the front yard only on Fridays. Licensee takes children on daily nature walks after 3:30pm for outdoor time. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.



At 11:05 am, during staff and children's file review, Licensee stated that she does not have any children's files for the 2 children that where present during today's inspection.

At 11:10am, Type Bs were cited for the the following:
  • Current in person ESMA approved CPR & 1st Aid training
  • AB1207 Mandated Reporter

Per Licensee stated she did not have the documents but will work on obtaining all of them. Licensee printed a roster during inspection.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
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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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911
VISIT DATE: 09/15/2023
NARRATIVE
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The following technical violations were given:
  • Fire extinguisher (FX) was fully charged, but needs to be serviced annually. FX was last serviced on 08/26/23
  • The stairs was not gated. Licensee put a gate during inspection.
  • Licensee did not have any required posted documentation. However, Licensee printed and posted during inspection.

Consult was given for the following:
  • Capacity increase
  • Technical Support Program (TSP)
  • Updating files: children's, staff, and physical file for the Regional Office.
  • Incidental Medical Services (IMS).

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage ahttps://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 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.

Licensee was reminded that all adults 18 and over, including employees and volunteers, expect 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 up assessed if this regulation is violated.

Licensee was informed of the MyChildCare.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resources and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
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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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911
VISIT DATE: 09/15/2023
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To improve the quality and value of the new inspection process, a survey will 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 them by email 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/process.

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

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR & H&S.



A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and explained. Exit interview conducted and report was reviewed with the Licensee, S. Fields- Benjamin.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2023 01:03 PM - It Cannot Be Edited


Created By: Susann Sanchez On 09/15/2023 at 12:13 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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. There was no proof of disaster drill conducted within the last 6 months and per Licensee, they have not conducted another drill. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Per Licensee a disaster drill will be conducted and documentation will be sent to LPA via picture. LPA provided a copy.
Type B
Section Cited
CCR
102417(g)(10)
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: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. LPA observe an infant in walker/saucer chair. LPA advise Licensee that walkers and saucer chairs is not safe and poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/15/2023
Plan of Correction
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Cleared during inspection.
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2023 01:03 PM - It Cannot Be Edited


Created By: Susann Sanchez On 09/15/2023 at 12:13 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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023

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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Based on record review and interview, the licensee did not comply with the section cited above: LPA did not observe mandated reporter training certificate for Licensee which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2023
Plan of Correction
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Licensee will provide proof of completion of mandated reporter training certificate to LPA via email by POC due date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee stated that she did not have proof of a current CPR & 1st Aid training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/13/2023
Plan of Correction
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Licensee will provide proof of completion of CPR & 1st Aid certificate to LPA via email by POC due date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2023


LIC809 (FAS) - (06/04)
Page: 6 of 10
Document Has Been Signed on 09/15/2023 01:03 PM - It Cannot Be Edited


Created By: Susann Sanchez On 09/15/2023 at 12:13 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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. Children's files are missing (LIC) 282- Affidavit Regarding Liability Insurance, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights LIC 9227 LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 9227- Infant sleep plan, 15-minute Infant Sleep Check. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2023
Plan of Correction
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Licensee will submitt a photo by POC due date of 10/06/23 via email. Licensee printed out forms during inspection.
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.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2023


LIC809 (FAS) - (06/04)
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