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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311352
Report Date: 01/22/2024
Date Signed: 01/22/2024 02:45:07 PM

Document Has Been Signed on 01/22/2024 02:45 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:BENAVIDES, VICKY & BENAVIDES, KARLAFACILITY NUMBER:
304311352
ADMINISTRATOR:BENAVIDES, V& K.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
7148341570
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Benaavides, Vicky & KarlaTIME COMPLETED:
03:15 PM
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On 1/22/2024, Licensing Program Analyst (LPA) A. Silva conducted an unannounced Required – 3 Year inspection assisted by licensees Vicky Benavides and Karla Benavides. Upon arrival, the licensees had 3 children in care, including two infants. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

INDOOR INSPECTION. The LPA inspected the indoor family day care area identified in the Facility Sketch LIC999 and areas accessible to clients. Off-limits areas were inaccessible to clients in care by means of child-proof gates at the time of inspection. The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. The licensee agrees to maintain telephone service in the home when clients are in care. The licensee are aware that each family daycare shall conduct fire drills and disaster drills at least once every six months. A record review shows that the last drill was documented on 12/2023. The fireplace is covered with a metal screen. The licensee stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care. A can of insecticide was observed during the inspection. The can was in the outdoor daycare area at a height of about 6ft. The licensee was informed that poisons must be locked when children are in care. The licensee stated that she had fumigated the outdoor area and forgot to put the can away. The licensee threw away the can of insecticide while the LPA was still present. A citation was issued. Clients nap on mats in the living room. According to the licensee, beddings are stored individually and washed weekly. The facility provides age-appropriate toys, play equipment, and materials for the clients served.

ON-SITE FOOD PREPARATION: The licensee provides food to the children. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. The LPA observed that the facility’s floors, equipment, furniture, and clients’ bathrooms were in good repair.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/22/2024 02:45 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 01/22/2024 at 01:54 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BENAVIDES, VICKY & BENAVIDES, KARLA
FACILITY NUMBER: 304311352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)(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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in one out of one insecticide cans accessible to children, which poses/posed a potential health, safety or personal rights risk to persons in care. A can of insecticide was observed in the outdoor daycare area at a height of about 6ft. The licensee stated she had used it in the outdoor area and forgot to remove it once finished. The licensee was informed poisons must be locked.
POC Due Date: 02/22/2024
Plan of Correction
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The licensee removed the can from the daycare area by throwing the can out. The licensee stated she will watch the video "Locks and Inacessibility Requirements in Child Care" located at https://ccld.childcarevideos.org/family-child-care-providers/locks-and-inaccessibility-regulations-in-child-care/ and send a declaration of completion to the LPA by the due date.
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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2024


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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BENAVIDES, VICKY & BENAVIDES, KARLA
FACILITY NUMBER: 304311352
VISIT DATE: 01/22/2024
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OUTDOOR INSPECTION: The playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the surface of the outdoor activity area was well-maintained and free of any observable hazards, aside from the can of insecticide documented above. There are no pools or other bodies of water in the home.

RECORDS: The LPA reviewed the licensees’ mandated reporter expires on 2/2024 and the Pediatric CPR/First Aid certification expires on 8/2024. The licensee has a current roster of clients. The LPA reviewed the records of three children who were present at the time of inspections. The records were in compliance with regulations.

This facility provides Incidental Medical Services – IMS. LPA reviewed the storage of medication, equipment, and supplies and reviewed children’s, personnel, and administrative records. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child.

The licensee understands that he or she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a qualified substitute adult to care for and supervise the children during his/her absence [A qualified substitute adult is an adult that has criminal record and child abuse index clearances, immunizations, and current Pediatric CPR/First Aid and Mandated Reporter training]. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day, in accordance with Section 102417 of the California Code of Regulations. The licensee understands that children are not to be left alone in parked vehicles.

The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BENAVIDES, VICKY & BENAVIDES, KARLA
FACILITY NUMBER: 304311352
VISIT DATE: 01/22/2024
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The licensee understands that a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year, in accordance with Section 1597.622 of the Health and Safety Code.

The licensee understands it is his or her responsibility to review the Provider Information Notices (PIN) found on the CCLD website below. If not yet registered, the licensee agrees to register to receive quarterly updates via email at childcareadvocatesprogram@dss.ca.gov or online at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe

The LPA discussed the following resources with the licensee:
US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY)
Commonly Asked Questions about Child Care Centers and the ADA link: http://www.ada.gov/childqanda.htm
CaSocialService YouTube Guardian Webinar “All Providers Webinar 12/20/22” link https://youtu.be/WNc1kYmlW9s
Guardian information link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
CCLD link: www.cdss.ca.gov/inforesources/community-care-licensing
CPSC (United States Consumer Product Safety Commission) link: https://www.cpsc.gov/

LPA reviewed the following safe sleep best practices with the licensee:
Always place infants 12 months and younger on their backs to sleep
Use only a tight-fitting sheet on the crib or play yard mattress
Do not hang any items from the crib or above the crib
Keep all items including blankets, pillows, and stuffed dolls out of the crib or play yard
Pacifiers may be used only if they do not have items attached to them and there is no recall
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BENAVIDES, VICKY & BENAVIDES, KARLA
FACILITY NUMBER: 304311352
VISIT DATE: 01/22/2024
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Infants should not be swaddled or have any items covering them while sleeping
The temperature of the room should be comfortable enough for a lightly clothed adult
Complete Individual Sleeping Plan LIC9227 for infants 12 months and younger
Conduct and document the 15-minute checks for all infants under 24 months
CDSS Safe Sleep link: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.

The facility was NOT in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 102417(g)(4)(A) Operation of A Family Child Care Home.

E-Learning videos, including Locks and Inaccessibility Requirements in Child Care, can be accessed at https://ccld.childcarevideos.org/family-child-care-providers/

The LPA conducted an exit interview and reviewed the report with the licensee. The “Notice of Site Visit” was posted and the licensee is aware that it shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the Regional Manager to the address listed above.

To improve the quality and value of the inspection process, a survey will be sent to the email address provided. Please complete the survey to share your inspection experience. If you have any questions regarding the process or tools used during the inspection, email them to inspectionprocess@dss.ca.gov. For more information about the inspection, its tools, and methods visit www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

End of Report.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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