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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018911
Report Date: 01/09/2026
Date Signed: 01/09/2026 02:32:24 PM

Document Has Been Signed on 01/09/2026 02:32 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:FIELDS-BENJAMIN FAMILY CHILD CAREFACILITY NUMBER:
198018911
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
01/09/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Licensee Shannon Fields-Benjamin,TIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Ashley Calderon on 1/9/2026 at 9:17am, conducted an annual/ random inspection and addressed the Licensees request for a Capacity of Increase - Capacity 14. LPA met with Licensee Shannon Fields-Benjamin, who allowed entrance into the facility. LPA disclosed purpose of today's inspection.

The fire department approved a max capacity of 14 children, dated 12/26/2025. LPA conducted a guided a tour of the facility alongside Licensee Shannon Fields-Benjamin. There were 6 children present ( 2 whom was an infant) and 5 adults present during the visit; Licensee , 2 staff assistant, 1 health care aid that assists the Licensee whom left at approx 9:30am and licensees God Daughter whom volunteers and assisted Licensee with today's visit. Individual residing in the home have been discussed and noted, currently no children reside in the home.

LPA received assistant via mobile with Guardian Roster from LPA Dayna Chambers; 2 assistants adults present were not eligible fingerprinted cleared for day care employees, and are listed as Home Care Aids and not associated under the Guardian Roster for the above facility, deficiency given. LPA provided LIC9163 LiveScan to get CACI, DOJ and FBI fingerprints; during the visit 2 staff assistants left to conduct appropriate livescan to assist at the day care. 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:

Facility currently in capacity is in compliance for a Small Family Child Care Home- Capacity 8. Hours of operation are Mon-Fri 6:00 AM - 6:00PM. Licensee is available 24/7 if needed. With the change of capacity request; facility plans to care for children 4 month old - 12 years old and change operation hours from Monday - Sunday from 6am-5am. LPA informed Licensee Fields-Benjamin absent of facility cannot exceed 20% of hours of operation.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2026
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.

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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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911
VISIT DATE: 01/09/2026
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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.

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


LPA reviewed Fire and Earthquake drill, dated 12/12/2025.LPA observed the kitchen, the cabinets under the sink have latches and is a storage area for chemicals, cleaning solutions and soaps. Licensee was aware to store any poisons in locked areas not only inaccessible with latches. 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. During the visit LPA observed staircase, there was no gate and children under the age of 5 were present at the facility, deficiency cited. LPA Calderon observed a rocking chair that was not being used by infants, Licensee placed it outside of the front door to discard rocking chair, consultation was given and LPA provided PIN 21-19CCP. Carbon and Smoke alarms were observed and are interconnected. Children when ill can use the on limit spaces that are not being used like the kitchen, living room or day care area. Per Licensee, the home does not have any pets, and no fire arms/ guns/ ammunition; LPA did not observe the following. Outside was fully fenced, with age appropriate toys inside and outside of the home. No bodies of water observed on premises.

LPA reviewed a total of 6 files. Infant #1 and Infant # 2 missing 15 sleep log, deficiency cited, Infant #2 parent is a volunteer (Licensee relative) and during visit completed LIC9227 Infant Sleep Plan was completed. Two children had the Nebulizer form, per Licensee treatment is done as needed due to both children having asthma. Per Licensee, their medication is currently not at the facility as they are not currently in need of medication. Licensee has a valid pediatric first aid and CPR expires 7/29/2027 and Mandated Reporter expires 10/3/2026. During the visit LPA provided copies of the Facility sketch and was given a plan ensuring Licensee can be present 80 % of the hours of operation. LPA received assistant from LPA Susann Sanchez via telephonically on Guardian did staff assistant transfer, for a individual who will assist at the day care in the time being that the 2 uncleared adults get fingerprinted cleared. LPA went over the process for individual clearances, provided LIC9182 and form was filled out and given to LPA Calderon to process a criminal background transfer request.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911
VISIT DATE: 01/09/2026
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  • 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.
  • 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.
  • The applicant/ Licensee provided proof of control of property during the small F.C.C initial application. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).
  • 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 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.
  • 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/.
  • 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.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: FIELDS-BENJAMIN FAMILY CHILD CARE
FACILITY NUMBER: 198018911
VISIT DATE: 01/09/2026
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During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee will have to do the following corrections and LPA Calderon will return to the home to check the following by 1/23/2026:
- Get a gate for the staircase.
- 15 min sleep log checks for Infants #1 and #2.
- Review of Qualified Staff file for Staff #3 (will start at day care) - Immunization records, personnel file , Mandated Reporter, Pediatric First Aid and Cpr, LIC-Employee Rights and Statement of Acknowledgment of Child Abuse LIC form.

Based on today’s visit, Per California Code of Regulations Title 22 facility was given 3 deficiencies and civil penalty for uncleared individuals present in the home.

LPA Ashley Calderon informed licensee Shannon Fields-Benjamin that this report dated 1/9/26 documents of (1) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Calderon informed the licensee Shannon Fields- Benjamin to provide a copy of this licensing report dated 1/9/26 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.

Licensee/ Applicant was advised that approval of the application for a Large Family Child Care will be determined upon review of Department and after corrections are completed.

Once licensed, the applicant is required to comply with Title 22 and with the terms and limitations stated on the License.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee/ Applicant Shannon Fields-Benjamin,

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/09/2026 02:32 PM - It Cannot Be Edited


Created By: Ashley Calderon On 01/09/2026 at 01:55 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: 01/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on assistant by LPA Dayna Chambers who reviewed the Guardian Roster record for the above facility; 2 assistants adults present were not eligible fingerprinted cleared for day care employees, and are listed as Home Care Aids and not associated under the Guardian Roster for the above facility, the licensee did not comply with the section cited above in [2] out of [2] staff assistants which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2026
Plan of Correction
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During the visit LIC9163 Live Scan was given and 2 staff were sent by Licensee Fields-Bemjamin to get Live Scan -DOJ, FBI and CACI done. Licensee will wait for their clearance to accept individuals back into the day care home and Licensee provided transfer LIC9182 for a individual who works at another day care who will assist Licensee.
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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/09/2026 02:32 PM - It Cannot Be Edited


Created By: Ashley Calderon On 01/09/2026 at 01:55 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: 01/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation no gate at the bottom of staircase, the licensee did not comply with the section cited above in 1 out of 1 staircase which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2026
Plan of Correction
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Licensee will get a new baby gate and get it placed at the bottom of the staircase. LPA will come back out to look at correction
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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Based on Infant #1 and #2 the licensee did not comply with the section cited above in 2 out of 2 enrolled infants which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2026
Plan of Correction
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Licensee showed LPA 15 min logs that were blank for Infant #1 and Infant #2 LPA Calderon will come to the facility to review logs to check consistency that sleep checks are being completed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


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