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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844458
Report Date: 05/15/2024
Date Signed: 05/15/2024 03:17:35 PM


Document Has Been Signed on 05/15/2024 03:17 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:BENITEZ FAMILY CHILD CAREFACILITY NUMBER:
364844458
ADMINISTRATOR:BENITEZ, KAREMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 440-5835
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:14CENSUS: 6DATE:
05/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Karem BenitezTIME COMPLETED:
03:30 PM
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to conduct an inspection regarding a separate matter. LPA met with Licensees Spouse (A1) who granted LPA entrance, 6 daycare children were present. Licensee Karem Benitez arrived later in the inspection.

When LPA arrived A1 was alone with 6 daycare children without a current CPR/First Aid Certificate.

Therefore, based on LPA observations, file review, and Licensees own admission, the Facility was found to be in violation of the following Title 22 Regulation:

102416 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.

See LIC809D for cited deficiency of the California Code of Regulations, Title 22.


A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with Licensee.

SUPERVISOR'S NAME: Ana NobleTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Laura MejoradoTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024
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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Document Has Been Signed on 05/15/2024 03:17 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: BENITEZ FAMILY CHILD CARE
FACILITY NUMBER: 364844458

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
Section Cited
CCR
102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid...
This requirement is not met as evidenced by:
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Licensee agrees to have A1 complete CPR/First Aid training and submit proof of training to CCL by 5/24/24.
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Based on LPA's observation, record review and Licensees own admission, A1 was alone, caring for daycare children without a current CPR/First Aid certificate, which poses a potential health, safety or personal rights risk to persons in care.
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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: Ana NobleTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Laura MejoradoTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024
LIC809 (FAS) - (06/04)
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