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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153905008
Report Date: 09/02/2022
Date Signed: 09/02/2022 03:08:21 PM

Document Has Been Signed on 09/02/2022 03:08 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BENITEZ, AGATHA FAMILY CHILD CAREFACILITY NUMBER:
153905008
ADMINISTRATOR:BENITEZ, AGATHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 717-3202
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
09/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Agatha Benitez - Licensee TIME COMPLETED:
03:20 PM
NARRATIVE
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On 9/2/2022, Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced Annual Required Inspection. LPA was met by Licensee Agatha Benitez. Days and hours of operation are Monday through Saturday, not to exceed 24 consecutive hours per child. LPA toured the home inside and outside and a census was taken. Licensee’s current facility sketch was reviewed, and Licensee confirmed that the bathroom, day-care room, living room and family room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of baby gates. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The fireplace located in the family room is made inaccessible by a child’s safety gate and will not be in use during day care hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are fenced or barricaded when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is 661-717-3202.

There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider was unable to provide proof that she physically checks on sleeping infants every fifteen minutes. LPA observed that one infant had fell asleep in their highchair during today’s inspection. Licensee was advised that upon any infant falling asleep, if they are not occupying a crib or play yard, they must be immediately placed inside a crib or play yard thereafter. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles (see next page, LIC809C).

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2022
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
Document Has Been Signed on 09/02/2022 03:08 PM - It Cannot Be Edited


Created By: Jessika Thompson On 09/02/2022 at 01:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BENITEZ, AGATHA FAMILY CHILD CARE
FACILITY NUMBER: 153905008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, as today, LPA observed an infant asleep in a highchair. Licensee stated that the infant had just finished eating, and had just fell asleep. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2022
Plan of Correction
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Licensee removed the infant from the highchair and placed them into a crib during today's inspection. Deficiency cleared at visit.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as today, Licensee was unable to provide LPA with proof of Mandated Reporter course completion for herself. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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Licensee stated that she will complete an AB1207 certified Child Abuse Mandated Reporter course. This training can be accessed by logging on to the following website: mandatedreporterca.com. After completion, licensee will maintain proof of certification within the family child care home. A return visit will be made by LPA after 9/23/22 to ensure the licensee has followed the above measures to correct this deficiency.
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:Susie Fanning
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 09/02/2022 03:08 PM - It Cannot Be Edited


Created By: Jessika Thompson On 09/02/2022 at 01:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BENITEZ, AGATHA FAMILY CHILD CARE
FACILITY NUMBER: 153905008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 2 staff files reviewed. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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Licensee will obtain proof of pertussis and measles immunization for Staff #2, to be stored on site at the facility. A return visit will be made by LPA after 9/23/22 to ensure the licensee has followed the above measures to correct this deficiency.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 10 children's files reviewed which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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Licensee stated she will obtain, and retain on file, completed Consent for Emegency Medical Treatment (LIC627s) for Child #1, Child #2, Child #3, and Child #10 by 9/23/22. A return visit will be made by LPA after 9/23/22 to ensure the licensee has followed the above measures to correct this deficiency.
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:Susie Fanning
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 09/02/2022 03:08 PM - It Cannot Be Edited


Created By: Jessika Thompson On 09/02/2022 at 01:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BENITEZ, AGATHA FAMILY CHILD CARE
FACILITY NUMBER: 153905008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 10 children's files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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Licensee stated she will obtain, and retain on file, proof of immunization records for Child #4, Child #5, Child #9, and Child #10 by 9/23/22. A return visit will be made by LPA after 9/23/2022 to ensure that all forms are on file.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 5 out of 10 children's files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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Licensee stated that she will obtain, and maintain on file, completed Liability Insurance Affidavit forms for Child #4, Child #5, Child #7, Child #9 and Child #10. A return visit will be made by LPA after 9/23/2022 to ensure that all forms are on file.
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:Susie Fanning
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022


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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BENITEZ, AGATHA FAMILY CHILD CARE
FACILITY NUMBER: 153905008
VISIT DATE: 09/02/2022
NARRATIVE
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Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. LPA reviewed a sample of children’s files and observed that several files were incomplete. Licensee’s Mandated Reporter Training has not been completed. Licensee’s pediatric CPR/First Aid expires on 2/17/2023. A review of records indicates that Staff #2’s file does not contain proof of pertussis and measles immunization. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. 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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
LIC809 (FAS) - (06/04)
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