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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
483008553
Report Date:
12/20/2022
Date Signed:
12/20/2022 02:00:08 PM
Document Has Been Signed on
12/20/2022 02:00 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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
ADMINISTRATOR:
BENEL, JUANA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(707) 642-1000
CITY:
VALLEJO
STATE:
CA
ZIP CODE:
94591
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
18
CENSUS:
5
DATE:
12/20/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:42 AM
MET WITH:
Juana Benel - Licensee
TIME COMPLETED:
02:20 PM
NARRATIVE
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A Required inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. A review of staff records on 12/20/2022 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently three adults residing in the home. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
During today’s inspection the home and grounds were toured. The Licensee (LS) was supervising five children, the facility was operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 5:00am - 6:30pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the entire second story which consist of four bedrooms and two bathrooms, and were made inaccessible by a child safety gate.
There is a working telephone in the home. There is a functional smoke detector and carbon monoxide detector; and a fully charged fire extinguisher rated at least 2A10BC. The fireplace was screened with a child size bookshelf. The staircase near the front entrance was barricaded with a child safety gate. Poison(s) were stored in an outdoor shed. There were no firearm(s) or other dangerous weapons stored on the premise.
LS did not furnish a current AB 1207 Mandated Reporter Training certificates for LS and staff (S1) that worked on 12/19/22. LPA reviewed
two Staff and two non-client adults (LS, S1, A1 & A2) records at 10:02am which revealed S1 & A2 were missing evidence of negative TB clearance and S1, A1 & A2 did not have completed LIC 508; and LS & S1 were missing proof of immunity against the Influenza.
(Continue to LIC 809-C)
SUPERVISORS NAME
:
Leslie Lepori
LICENSING EVALUATOR NAME
:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
10
Document Has Been Signed on
12/20/2022 02:00 PM
- It Cannot Be Edited
Created By:
Melchisedeck Augustin
On
12/20/2022
at
11:57 AM
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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/20/2022
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
1
2
3
4
Based on LPA's review of the facility's disaster drill that was posted on the parent board near the entry door which revealed the Licensee had not conducted an emergency disaster drill within the past six months. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
Licensee stated she would conduct an emergency disaster drill, she would document the details of the drill, and submit the disaster drill log and evidence to show a drill was conducted with the children. Licensee intends to submit POC to the Department by 01/10/23 via mail, email or fax.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the Licensee not furnishing evidence to prove she conducted 15 minute checks while children (C1, C2, & C4) under 24 months old napped. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
Licensee stated she would produce a written statement detailing her intentions to complete Infant Sleep log for each infant under 24 months old while they infants take a nap, and the Licensee intends to submit the written plan to the Department by 01/10/23.
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:
Leslie Lepori
LICENSING EVALUATOR NAME:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
Page:
2
of
10
Document Has Been Signed on
12/20/2022 02:00 PM
- It Cannot Be Edited
Created By:
Melchisedeck Augustin
On
12/20/2022
at
11:57 AM
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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/20/2022
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
1
2
3
4
Based on review of the Licensee's AB 1207 Mandated Reporter Training certificate which revealed the certificate was expired. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
02/03/2023
Plan of Correction
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2
3
4
Licensee stated she and S1 would complete the online AB 1207 Mandated Reporter Training module at mandatedreporterca.com and Licensee would submit LS & S1's certificates to the Department by 02/03/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on two staff (LS & S1) records reviewed at 10:02am which revealed LS and S1 were missing proof of immunity against Influenza. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
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3
4
Licensee stated she and S1 would obtain their proof of immunity against the Influenza and Licensee would submit the required records to the Department by 01/10/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
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:
Leslie Lepori
LICENSING EVALUATOR NAME:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
Page:
3
of
10
Document Has Been Signed on
12/20/2022 02:00 PM
- It Cannot Be Edited
Created By:
Melchisedeck Augustin
On
12/20/2022
at
11:57 AM
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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/20/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(11)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (11) A signed statement regarding their criminal record history as required by Section 102370(c).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on staff and adult records reviewed at 10:02am which revealed (LS, S1, A1 & A2) S1, A1 & A2 were missing completed LIC 508. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
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2
3
4
LPA provided the Licensee with three blank copies of the LIC 508, the Licensee intends to provide the licensing forms to the S1, A1 & A2, and upon completion of the forms, the Licensee would submit the completed forms to the Department by mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on children's records reviewed which revealed C1, C5 & C6's LIC 700 were incomplete. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
Licensee stated she would return the LIC 700 to the children's parents to request full completion of the forms, and the Licensee intends to submit the completed forms to the Department by 01/10/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
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:
Leslie Lepori
LICENSING EVALUATOR NAME:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
Page:
4
of
10
Document Has Been Signed on
12/20/2022 02:00 PM
- It Cannot Be Edited
Created By:
Melchisedeck Augustin
On
12/20/2022
at
11:57 AM
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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/20/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the Licensee not furnishing evidence to prove C3, C4 & C7 were immunized against diseases. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
LPA intends to conduct a follow up inspection to review the children's records on or after POC due date.
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the Licensee not furnishing records for three children (C3, C4 & C7) that were present during the visit. The licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
LPA intends to conduct a follow up inspection to review the children's records on or after 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:
Leslie Lepori
LICENSING EVALUATOR NAME:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
Page:
5
of
10
Document Has Been Signed on
12/20/2022 02:00 PM
- It Cannot Be Edited
Created By:
Melchisedeck Augustin
On
12/20/2022
at
11:57 AM
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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/20/2022
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
1
2
3
4
Based on the Licensee not furnishing records for several children (C3, C4 & C7) that were present during the inspection. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
LPA intends to conduct a follow up inspection to review the children's records on or after POC due date.
Type B
Section Cited
CCR
102421(c)
Child's Records
(c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on the Licensee not furnish evidence to prove four school age children were enrolled into elementary school as required by CCR 102416.5(b). The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
Licensee stated she would request proof of the children's enrollment into school from the children's parents, and the Licensee would submit evidence of the children's enrollment to the Department by 01/10/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.
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:
Leslie Lepori
LICENSING EVALUATOR NAME:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
Page:
6
of
10
Document Has Been Signed on
12/20/2022 02:00 PM
- It Cannot Be Edited
Created By:
Melchisedeck Augustin
On
12/20/2022
at
11:57 AM
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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/20/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's review of the facility roster of the children currently in care which appeared to be incomplete. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
The Licensee stated she would record the names and information of the children enrolled into care on the LIC 9040, and the Licensee would submit all pages of the complete facility roster to the Department by 01/10/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.
Type B
Section Cited
CCR
102369(b)(9)
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on staff and adults (LS, S1, A1 & A2) records reviewed at 10:02am which revealed S1 & A2's records did not contain evidence of negative TB clearance. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2023
Plan of Correction
1
2
3
4
Licensee stated she would ensure S1 & A2 obtain evidence of negative TB clearance and Licensee would submit S1 & A2's evidence of negative TB clearance to the Department by 01/10/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.
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:
Leslie Lepori
LICENSING EVALUATOR NAME:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
Page:
7
of
10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
VISIT DATE:
12/20/2022
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
26
27
28
29
30
31
32
LPA requested seven (C1-C7) children’s records, however; Licensee furnished four records (C1, C2, C5-C6) which were reviewed at 10:34am and revealed C1’s licensing (LIC) forms 282, LIC 995A, 627, and 700 & 9150 were either missing, incomplete or not signed. C2 & C5’s records were missing LIC 9150 and C6 was missing LIC 282 and 9150, and C5 & C6’s LIC 700 were incomplete. The Licensee did not furnish evidence of immunization against diseases for three children that were present. During the visit, the Licensee stated she transported four school age children to school, however; the Licensee did not furnish evidence to prove the children's enrollment in elementary school as required in CCR 102416.5(g).
During today’s inspection, Licensee stated there was/were three children (C1, C2 & C4) under 24 months enrolled into care and the Licensee did not furnish evidence to prove she conducted 15-minute checks while the infants napped. According to the disaster drill log that was posted on the parent board near the front entry door, the facility had not conducted an emergency disaster drill within the past six months. The facility roster of the children in care was reviewed and appeared to be incomplete. The Licensee furnished a current EMSA approved pediatric CPR/First Aid certification which expire on 09/2024. The backyard appeared to be free of hazards and was fully fenced, and there were no pools or other bodies of water observed in the yard. LPA did not observe any baby walker(s), bouncer(s) and/or jumper(s).
The facility is not providing Incidental Medical Services (IMS) to children in care. 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 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 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. (Continue to LIC 809-C)
SUPERVISORS NAME
:
Leslie Lepori
LICENSING EVALUATOR NAME
:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
Page:
9
of
10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BENEL, JUANA FCCH
FACILITY NUMBER:
483008553
VISIT DATE:
12/20/2022
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A notice of site visit was given and must remain posted for 30 days
. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee, Juana Benel. The following violation(s) of the California Code of Regulations, Title 22; Division 12 were cited during today’s inspection. Appeal Rights were provided.
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 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
.
SUPERVISORS NAME
:
Leslie Lepori
LICENSING EVALUATOR NAME
:
Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2022
LIC809
(FAS) - (06/04)
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