013416941-8-22-2024-52-CC-RMIA-D8DUMX-20240822154304

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013416941
Report Date: 08/22/2024
Date Signed: 08/22/2024 03:44:47 PM

Document Has Been Signed on 08/22/2024 03:44 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	BENITEZ, ROSA AND MARITZA		FACILITY NUMBER:	013416941
ADMINISTRATOR:	BENITEZ, ROSA AND MARITZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 744-1379
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	14	CENSUS: 4	DATE:	08/22/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:07 PM
MET WITH:	Rosa Maritza		TIME COMPLETED:	03:45 PM

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On August 22, 2024 1:07pm Licensing Program Analyst (LPA) Randy Miranda arrived for an unannounced annual inspection for Health & Safety. Present for today’s inspection was the licensees Rosa and Maritza Benitez, 4 children in care ([1] infant, [2] 3 year old, and [1] 5 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 products with the wording "Keep out of Reach of Children" must be stored, locked away, and kept inaccessible to children in care.

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 3-A:40-B:C 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 07/17/2024.

*See LIC809C Page 2*

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Randy Miranda	TELEPHONE: (510) 359-0974
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BENITEZ, ROSA AND MARITZA	FACILITY NUMBER: 013416941
	VISIT DATE: 08/22/2024

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*Page 2 cont.*

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 have required immunizations. CPR/1^st Aid expire on 08/26/2025. Licensee Rosa Benitez's Mandated Reporter expire on 05/19/2025 and Licensee Maritza Benitez's Mandated Reporter expire on 07/29/2025. 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.

*See LIC809C Page 3*

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Randy Miranda	TELEPHONE: (510) 359-0974
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BENITEZ, ROSA AND MARITZA	FACILITY NUMBER: 013416941
	VISIT DATE: 08/22/2024

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*Page 3 cont.*

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.

No Deficiencies were issued today.

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Randy Miranda	TELEPHONE: (510) 359-0974
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

LIC809 (FAS) - (06/04)

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