543907665-7-3-2019-04-CC-TMAZ-BDQQ29-20190703114646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543907665
Report Date: 07/03/2019
Date Signed: 07/03/2019 11:46:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	BENEVEDES, CHRISTINE & MCCOY, MORIAH FCC		FACILITY NUMBER:	543907665
ADMINISTRATOR:	BENEVEDES, CHRISTINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 736-3790
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	14	CENSUS: 14	DATE:	07/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Christine Benevedes		TIME COMPLETED:	11:45 AM

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Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced Annual inspection and met with Licensee Christine Benevedes. Also present was Assistant Moriah McCoy. The working telephone number was verified. Postings such as facility license, Emergency Disaster Plan, Earthquake preparedness checklist, and Notification of Parent’s Rights are posted on the front entry wall.

LPA Marquez conducted a tour of the home, inside and outside. The rooms accessible to children in care: the living room, the class room, kitchen/dining area, hall bathroom and fenced backyard. Off-limits rooms are made inaccessible via children’s safety gates. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is screened and inaccessible to children in care. A working fire extinguisher is present. A smoke detector and carbon monoxide indicator were tested and observed to be operational. There are no stairs in the home.

Children are supervised when outside in the fenced play area. The home does not have pets. There are no "bodies of water" or firearms in this home. Poisons are locked in accordance to Title 22 regulations.

Licensee has a current roster of the children. A random sample of Children’s files were reviewed for documentation of immunizations. Staff files were reviewed for record for herself and staff. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Right (LIC995A). The most recent fire drill was conducted and documented on 06/10/2019. All adults who reside or work in the home have a criminal record clearance and/or exemption. Pediatric CPR/First Aid is current and expires 11/21/2010. Mandated Reporter training AB 1207 is current and expires 3/30/2020. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice.

Days and hours of operation are Monday – Friday; 4:30 AM – 10:30 PM and other hours as arranged.

(Continued on LIC809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BENEVEDES, CHRISTINE & MCCOY, MORIAH FCC	FACILITY NUMBER: 543907665
	VISIT DATE: 07/03/2019

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LPA & Licensee discussed the Community Care Licensing (CCL) additions to the website that include the Provider Information Notifications (PIN), including the Quarterly Updates that informs licensees of new legislation and regulations.

LPA discussed Incidental Medical Services (IMS) and provided Licensee with a copy of the Plan for IMS – Family Child Care Home Requirements (FCCH). For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for FCCH Section 102417. No IMS are being provided at this time.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.

THE LICENSING FORM LIC9213 NOTICE OF SITE VISIT IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019

LIC809 (FAS) - (06/04)

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