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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500598
Report Date: 04/19/2022
Date Signed: 04/19/2022 11:34:15 AM


Document Has Been Signed on 04/19/2022 11:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:BENSON, ROBYNFACILITY NUMBER:
574500598
ADMINISTRATOR:BENSON, ROBYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 304-8490
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY:14CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Robyn Benson, LicenseeTIME COMPLETED:
11:40 AM
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Licensing Program Analysts (LPAs) Salene Mayberry and Christopher Jackson met with Licensee, Robyn Benson for the purpose of conducting a change of location inspection. Present during the inspection was Licensee's adult child. Licensee is requesting a change of location from her old facility with license #574500279 to her current location.

All adults living and working in the facility have a criminal record clearance. Licensee 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.

The facility is a one-story home that consists of 2 bedrooms, 2 playrooms at the rear of the home and 2 bathrooms. LPAs and Licensee toured the entire home inside and outside. Off limit areas consist of both bedrooms and the laundry room. Licensee acknowledged that children are never allowed in the off-limit areas. Off limit areas will remain inaccessible by door handle covers, locked closed doors and supervision. Licensee understands that 100% supervision is required when children play any unfenced areas.

LPAs discussed licensing requirements with Licensee including the posting of licensing inspection notices and reports, as well as injury and incident reporting. A 2A10 fire extinguisher and first aid kit are located in the closet of playroom #1. Smoke alarm and carbon monoxide detectors were observed to be in operational order. On April 19, 2022, LPA Mayberry received the completed fire clearance from the Winters Fire Department clearing the home for a large capacity Family Child Care Home.

Continue 809-C.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: BENSON, ROBYN
FACILITY NUMBER: 574500598
VISIT DATE: 04/19/2022
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There are no bodies of water on the property. The fireplace in the home is appropriately blocked by a screen and gate. Hazardous items and personal hygiene items are made inaccessible to children. Sharp utensils are stored in locked drawers. Licensee has a current Mandated Reporter Training Certificate that expires 05/2022. Current pediatric CPR and first aid training was verified and expires 04/16/2024.

In addition, LPA’s discussed the infant safe sleep regulations with Licensee. LPAs discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. LPA’s provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for Licensee during today's inspection, and shard 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. LPAs also informed Licensee 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.

Licensee currently does not have any children enrolled that require IMS. LPAs discussed IMS services and the requirement to create a plan of operation if needed in the future. 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.

LPAs discussed with Licensee the LIC311D, Forms/Records to Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Licensee understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Licensee understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and an Unusual Incident Report LIC624 shall be submitted within 7 days to remain in compliance. Licensee understands that if any structural changes are made to the home; licensing must be notified prior to construction.

Continue 809-C.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: BENSON, ROBYN
FACILITY NUMBER: 574500598
VISIT DATE: 04/19/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

An Exit interview conducted, and the report was reviewed with the Licensee.

A provisional license will be granted today and upon Licensee providing completion of the Health and Safety Training course, the home will be approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without an assistant, the ratios revert to those for small family childcare home.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
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