304313540-6-9-2020-06-CC-KDEI-BQEQX2-20200609123248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313540
Report Date: 06/09/2020
Date Signed: 06/09/2020 12:33:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	BENSON, MARINA		FACILITY NUMBER:	304313540
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 8	DATE:	06/09/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee Benson Marina		TIME COMPLETED:	12:45 PM

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	Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced Case Management - Licensee Initiated, Tele inspection via Face time, due to Pandemic situation, following the increase in capacity as requested by the Licensee. Fire clearance was approved and remains on file. LPA conducted the tele inspection with the Licensee Ms. Benson Marina who gave a tour of the home via Face time. Also present during this inspection, was Ms Goliuk Liudmyla, Licensee’s Assistant, who was providing care and supervision to eight children. A current children’s roster is available and is current. Due to Pandemic, Licensee currently is operating under the Blanket Waiver as a Large Family Child care home. Home is two story, has 4 bedrooms and 3 bathrooms. Licensee has designated the following areas of the home as off limits and inaccessible to children: upstairs, garage, and laundry room. The stairway leading upstairs is blocked by a child proof gate, kitchen door has high latch and door locks to prevent the children from entering the off-limit rooms in the rest of the home. There are age appropriate toys available for children. Licensee has designated the large two living area as play room, bedroom is designated area for children to take naps and there is a bathroom for day care children meeting the requirements. Children enter through the front yard, walk through the side fenced gate and enter through the back door into the play area, due to Covid 19, parents do not enter the facility, front porch is the area where children place their belongings before walking through the side fenced gate. Posters are posted in the front porch area. The licensee states that 2 adults and 1 minor child currently live in the home. Licensee states that she currently has two assistants. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). The following was observed and reviewed during this inspection.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BENSON, MARINA	FACILITY NUMBER: 304313540
	VISIT DATE: 06/09/2020

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PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

All children nap in the designated bedroom area downstairs. Children use cots for napping, cot sheets are provided by the Licensee and linens are brought from home but are washed by the licensee on a weekly basis.
The licensee provides food for children in care. (AM/PM snacks and Lunch) Water dispenser is placed in the day care area for easy assess to water and some children also bring in their own personal bottles.

Play room was observed to have educational, arts and crafts items along with age appropriate toys in arranged cubbies, which were accessible to children.

Out door activities are held in the backyard, which is fenced from all the sides and is free of hazards. LPA observed age appropriate play structures placed on a turf grass carpet and sand underneath to absorb the falls, additional toys were also observed. The covered patio area is also used for table top activities and if weather is permissible children do lunch activities on the tables. Out door area was observed to clean with age appropriate toys and equipment's which were clean and free of any sharp objects.
The corner section of the yard is made inaccessible to children by placing a fence.
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There are no bodies of water on the premises. Licensee stated there are no firearms on the premises. LPA advised anytime when firearms are present, they must be locked and stored separately from the ammunition

The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors were tested and are operable.

The licensee is observed to be operating within the license capacity limitations.

The Licensee have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR is valid through 6/2022. There are first aid supplies available

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BENSON, MARINA	FACILITY NUMBER: 304313540
	VISIT DATE: 06/09/2020

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The home is observed to be clean and orderly. There is heating and ventilation for safety and comfort. Where children are less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. There are toys available for children. There is a fire place in the home, which is completely covered by a ply wood sheet with a decorative art work.

The licensee states the current cell phone is used as the main contact number for the facility.

Children’s records were not reviewed, during this Tele inspection , per Licensee they are storied in a filing cabinet with the required documents including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

H&S 1597.622: Commencing September 1, 2016, 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. The licensee does have proof of immunization against influenza, pertussis, and measles.

The following items were also discussed with licensee during this inspection.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.

PETS: There are no pets in the home at the time of inspection.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted.
PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.

Infant Care: Licensee states that currently there are no infants enrolled.

LPA emailed the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BENSON, MARINA	FACILITY NUMBER: 304313540
	VISIT DATE: 06/09/2020

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Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
Licensee was reminded to ensure proper association and transfer is completed before hiring any new staff to provide additional care and supervision..

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.

Capacity Handout (Small & Large) was emailed to the Licensee.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

At this time, the licensee is in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.
A new license for operating a Large Family Child Care Home shall be issued upon approval.

The report is being emailed to the Licensee, due to Covid 19 pandemic and LPA has requested a written acknowledgement of the report being read.
Appeal Rights were also emailed to the Licensee.
No deficiency cited during today's tele-inspection

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020

LIC809 (FAS) - (06/04)

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