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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480105666
Report Date: 08/20/2019
Date Signed: 08/20/2019 02:48:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BENICIA CHILD DEVELOPMENT UNITFACILITY NUMBER:
480105666
ADMINISTRATOR:REGIS, JUNEFACILITY TYPE:
850
ADDRESS:2015 EAST THIRD STREETTELEPHONE:
(707) 747-8367
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY:21CENSUS: 10DATE:
08/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Diane AltmanTIME COMPLETED:
01:00 PM
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An Annual Random inspection was made to the facility by Licensing Program Analyst (LPA), Glenn Ouye. The facility file was reviewed prior to this inspection. A review of the personnel report on indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This program is operated by the Benicia Unified School District and a Title 5 funded program.

The facility’s operating hours are 7:00am to 6:00pm, Monday – Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Poisons are not stored at the facility. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors at the sink and outdoors in the play yard drinking fountains. The children’s bathrooms were in safe and sanitary condition. A current menu was posted in the classroom with the required postings. Food is prepared in the school kitchen and brought to the class room. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The lead teacher stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were ten children were being supervised by three teachers/aides. The facility was operating within the licensed capacity. All staff member present during the visit possessed current CPR and First Aid certifications which is valid through August 2020. Four children’s records were reviewed at 12:30pm, and contained identification forms with authorized representative information, as well as medical assessments. Two staff records were reviewed at 12:45pm, and contained health screening forms. The sign in/out procedure was reviewed and in compliance.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: BENICIA CHILD DEVELOPMENT UNIT
FACILITY NUMBER: 480105666
VISIT DATE: 08/20/2019
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This facility is not providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed with the Director. (LPA reviewed storage location of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.) For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019
LIC809 (FAS) - (06/04)
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