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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416941
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:05:58 PM


Document Has Been Signed on 04/14/2023 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:BENITEZ, ROSA AND MARITZAFACILITY NUMBER:
013416941
ADMINISTRATOR:BENITEZ, ROSA AND MARITZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 744-1379
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 3DATE:
04/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Rosa BenitezTIME COMPLETED:
04:15 PM
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On April 14, 2023 at approximately 12:55pm Licensing Program Analyst (LPA) Haderer arrived for an unannounced annual inspection for Health & Safety. Present for today’s inspection was the licensees Rosa and Maritza Benitez, 3 children in care (2 infants, and 1 four year old). The facility is in ratio today. Hours of operation are Monday -Friday 7:00am 4:30pm.

The facility is a single-story home with a built-on mother-in-law unit on the second floor with private access and not included in the child care home. The first floor has 4 bedrooms; 2 bathrooms; living room; family room; kitchen; attached 2-car garage; front, back and side yards. There is no fireplace in the home. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the northern napping bedroom away from the other children in care. All required postings are present.

ON LIMIT AREAS: Kitchen; dining room; living room; family room (day care area); bedroom/playroom next to family room, 2 bedrooms on opposite sides of the hallway, hallway bathroom, backyard. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products.



OFF LIMIT AREAS: Master bedroom/bathroom, attached 2-car garage, backyard shed, 2nd floor bedroom/bathroom mother in-law unit (which is accessible only from the backyard); western side of the back side yard of the home. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.

The home has a fully charged 3A40BC fire extinguisher in the kitchen, smoke and carbon monoxide detectors (tested and working) and a working telephone. Fire drills are conducted monthly, the last drill was completed in February 15, 2023.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BENITEZ, ROSA AND MARITZA
FACILITY NUMBER: 013416941
VISIT DATE: 04/14/2023
NARRATIVE
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Licensee has ample age-appropriate toys and learning materials inside and outside the home. The outdoor play area is free from defects and dangerous conditions. Per licensee, there are no firearms in the home. Drop-down cribs are not allowed at the day-care facility. No toxins, medicines, and hazardous items were accessible during today's inspection.

LPA reviewed facility files including records for licensee and Children’s files. Children’s files were complete and well organized. The facility roster was reviewed, and a copy obtained. All files were organized and complete. The licensee owns the property and does not carry liability insurance, all children’s file contained the LIC282 Notice of No Liability Insurance. Licensee’s helper does not have personnel records. Licensee asked to compile personnel records.

Licensee's have required immunizations. CPR/1st Aid have expired on 10/10/2022 – see LIC809D for deficiency. Mandated Reporter was completed on 5/16/2021, certificate is in licensee Rosa Benitez’ name. Licensee Maritza Benitez and helper Megan Rolfes completed the training together but did not get individual certificates. Last year a technical violation issued to advise Maritza and Megan to take Mandated Reporter training and everyone get certificates in their own name – See LIC809D for deficiency. Licensee was reminded that CPR/1st Aide and Mandated Reporter is to be renewed every two years.

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

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.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BENITEZ, ROSA AND MARITZA
FACILITY NUMBER: 013416941
VISIT DATE: 04/14/2023
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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 [facility representative] 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.

There were 2 deficiencies issued today, See LIC809D.

- Expired CPR/1st Aid certificates

- Mandated Reporter certificates not in each person's name

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the licensee Rosa Benitez.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/14/2023 04:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: BENITEZ, ROSA AND MARITZA
FACILITY NUMBER: 013416941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023

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, the licensee did not comply with the section cited above in that licensee Maritza Benitez and helper Megan Rolfes all took the Mandated Reporter together but only received one certificate in licensee Rosa Benitez' name. Each person in the facility must have their own Mandated Reporter certificate (AB1207) and renewed every two years otherwise it poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/15/2023
Plan of Correction
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Mandated Reporter certificates must be renewed in each person's name and renewed every two years.
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 record review, the licensee did not comply with the section cited above in that both licensee's CPR/1st Aid certificates expired 10/10/2022 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/15/2023
Plan of Correction
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Licensee Rosa Benitez and Maritza Benitez must renew their CPR/1st Aid training and get new certificates. CPR and 1st Aid are required to be renewed every two years.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5