<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313914
Report Date: 01/04/2022
Date Signed: 01/04/2022 11:49:22 AM

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:JAIMES, BENITAFACILITY NUMBER:
304313914
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
01/04/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee Ms. Jaimes, Benita TIME COMPLETED:
12:00 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’s (LPA) Ketki Desai conducted an unannounced In-person Case Management. License initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee Ms. Jaimes, Benita present at the site, providing care and supervision to children. At the time of inspection there was 3 infants, 1 toddler and 2 preschool age children. Licensee has held a license for Small Family Child Care home since 11/2019, qualifying to operate a Large Family Child care home.

A review of the Facility Personnel Report Summary indicates all adults, residing in the home who require caregiver background check clearances are cleared.
Licensee is requesting a Large family childcare home license. Per Licensee, operation hours will be Monday to Friday, 8:00 am to 5:00 PM. Licensee states that she will care for Infants 3 months to School age children (12).
This is a two bedroom apartment on the first level in the apartment complex. The home has two bedrooms, two bathrooms, living room, kitchen, dining room, laundry room and patio.

Licensee have designated he living room, dining room, one bathroom, and patio as part of her day-care.
Licensee has designated kitchen, two bedrooms, one bathroom, and laundry room as the off-limit areas, safety gate has been installed at the entrance of the kitchen, and at the entrance way leading to the off-limit bedrooms, and the one bathroom, ensuring these areas are inaccessible to the children in care.

All areas identified on the facility sketch that the children will use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. Cell phone is used for Day care communication. The home has a central Air /Heating system. The A/C unit is in the area inaccessible to children
Page-1
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
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 6
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: JAIMES, BENITA
FACILITY NUMBER: 304313914
VISIT DATE: 01/04/2022
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
Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: kitchen / two bedrooms / laundry room as off limit areas. There is child safety gate installed at the entrance of the kitchen and a second child safety gate at the entrance way leading to the off-limit bedrooms, and the one bathroom, ensuring these areas are inaccessible to the children in care. During Inspection LPA observed the off limit bedroom doors were closed and locked. Kitchen gate was also closed. Laundry room door was also locked.
There is no Fire place or stairway in the home.
Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.
LPA also observed COVID19, precautions at the facility, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups.

Areas Designated for Day care activities: Licensee have designated the living area/ dining area, one bathroom and fenced patio area for Day care activities.

The Living area was observed to have age appropriate activities (Toys/ books / arts / crafts) and educational items for Preschool and School age children. The Living room is divided in two sections with a wooden child safety gate, designating one area for Infants, while the other side has small table and chairs with changing table and cribs. There is a storage cubby for children where their personal items are stored. Licensee has arranged the activities for Infants in the infant area, while other side has activities for Preschool and School age children. During nap time cots are used for older children, linens and blankets are provided by the Licensee , stored in their individual cubbies and are washed on premises on a weekly basis. while younger infants sleep in the cribs and pac & play . Each infant has their own sleeping crib.

The bathroom designated for day care use was observed to be safe and free of hazardous items. Bathroom has a small step stool so children can reach the sink tap. Bathroom is located next to the bedroom and they do open the safety gate to access the bathroom. Sink cabinets has child safety stoppers.

Licensee has age appropriate furniture and items for the ages served. Infant items are provided by the parents. (Page 2 )

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: JAIMES, BENITA
FACILITY NUMBER: 304313914
VISIT DATE: 01/04/2022
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
OUTDOOR PLAY AREA: Licensee has designated the long patio area for outdoor activities. It is accessed through the sliding door in the dining area. It has concrete flooring with five ft fence surrounding it. Licensee has arranged several age appropriate outdoor activities for children.

Per applicant, there are no firearms, weapons or bodies of water on the premises. There is community swimming pool, located approximately 600 feet from the facility, which meets Title 22 regulations 102417(g)(5) requirements.
Licensee has two small pet dogs, during operating hours the pets are kept in the off- limit areas.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

Licensee states that she provides Early Morning snack/ Breakfast/ Lunch and late evening snack for children in care. If food is brought from children’s homes, those containers shall be labeled with child’s name and properly stored or refrigerated.

Licensee has completed the required Pediatric First Aid and CPR which remains valid upto 1/2023 There are first aid supplies available.

Licensee was made aware of Infant care and PIN 20-24CCP was also discussed with the Licensee and the Safe sleep regulation.

The following was discussed with the Licensee: Ms. Jaimes, Benita 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.



In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification, TB clearance along with a valid criminal record clearance associated to the facility license.
(Page-3)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: JAIMES, BENITA
FACILITY NUMBER: 304313914
VISIT DATE: 01/04/2022
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
Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.·

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Licensee was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.



Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, no infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

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 (Page-4)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: JAIMES, BENITA
FACILITY NUMBER: 304313914
VISIT DATE: 01/04/2022
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
Licensee provides Infant care and following was reviewed and new PIN released in September was shared.

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:

English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf



A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

LPA reviewed with applicant the following safe sleep best practices:
*Always place infants on their backs for sleeping
*Use only a tight-fitting sheet on the crib or play yard mattress
*Do not hang any items from the crib or above the crib
*Keep all items, including blankets, out of the crib or play yard
*Pacifiers may be used as long as they do not have items attached to them
*Infants should not be swaddled or have any items covering them while sleeping
*The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold

Infant care: Licensee provides Infant care, all Infant items : diapers / wipes/ lotions and milk shall be provided by the parents. Mother's milk shall be labeled and stored appropriately. There is a changing table/ sleeping cribs, high chair and play mats for the infants. Licensee shall ensure the infants are supervised at all times during her care.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: JAIMES, BENITA
FACILITY NUMBER: 304313914
VISIT DATE: 01/04/2022
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
Safe Sleep : LPA discussed the safe sleep regulations with Licensee Ms. Jaimes, Benita 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 Applicant Ms. Jaimes, Benita 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.

OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)


Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Fire inspection from Orange County Fire Authority Fire inspection services have granted the fire clearance

The licensee does have a current roster of children in care. Six files were reviewed and meets the requirements.
Licensee has access to the new Guardian Background check system.

The facility was complying for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, in the event additional requirements are needed, the Licensee will be notified.

On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s.

An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6