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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215399
Report Date: 08/11/2023
Date Signed: 08/11/2023 04:05:25 PM


Document Has Been Signed on 08/11/2023 04:05 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:BENEFIELD, DEBORAHFACILITY NUMBER:
010215399
ADMINISTRATOR:BENEFIELD, DEBORAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 695-6550
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 3DATE:
08/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Deborah BenefieldTIME COMPLETED:
04:16 PM
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On August 11, 2023 at 12:47pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Deborah Benefield for the purpose of conducting an unannounced 1-year annual inspection. Present for today’s inspection were the Licensee, her fingerprint cleared Husband, preschool age great-grandson, an infant, and another preschool age child. Hours of operation are Monday - Friday 6:30am-5pm.

The facility is a single story home consisting of three bedrooms, two bathrooms, living room, dining room, kitchen, fully fenced in front yard and fully fenced in backyard.

ON LIMIT AREAS: Bathroom across the dining room, the first bedroom straight ahead from the main entrance, living room, dining room, kitchen, and front yard.

OFF LIMIT AREAS: The bedroom to the left of the bathroom, the bedroom in the back of the house with the bathroom attached, and the backyard

ISOLATION AREA: on the couch in the living room

The home has heating and ventilation for safety and comfort. The home has a fully charged 2A10BC fire extinguisher in the kitchen. There is a working smoke detector, carbon monoxide detector, and a working telephone. Licensee has ample age-appropriate toys and learning materials inside and outside the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee utilizes her front yard and the local park for outdoor play. LPA reviewed children's and the Licensee's file. The facility roster was reviewed, and a copy obtained. The Licensee had a current Mandated Reporter certificate which expires July 21, 2024 and CPR expires July 2024. The last fire/disaster drill was conducted on August 11, 2023.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information **********************************Report Continues on LIC 809-C*******************************

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BENEFIELD, DEBORAH
FACILITY NUMBER: 010215399
VISIT DATE: 08/11/2023
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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
- 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.
- 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.
- 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.
- 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/inspection-process.
- Licensee was provided with the Infant Safe Sleep Regulations and an infant sleep log template.
- During the exit interview, the Licensee Deborah Benefield, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There were no deficiencies cited during today's visit.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee, Deborah Benefield.
Report and Appeal Rights were provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
LIC809 (FAS) - (06/04)
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