155620147-3-22-2023-57-CC-NLOI-CQ6QYK-20230322123517

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 155620147
Report Date: 03/22/2023
Date Signed: 03/22/2023 12:35:31 PM

Document Has Been Signed on 03/22/2023 12:35 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-LOPEZ, MARTHA FAMILY CHILD CARE		FACILITY NUMBER:	155620147
ADMINISTRATOR:	BENITEZ-LOPEZ, MARTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 444-1199
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93313
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/22/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Martha Benitez-Lopez		TIME COMPLETED:	12:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 3/23/23, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Martha Benitez-Lopez for a pre-licensing/ change of location inspection. Applicant, her husband, her adult brother, her adult son, and one minor child reside in the home. Verified applicant’s and Applicant’s Assistant’s, Francisco Gomez, CPR and First Aid was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on 4/17/23. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on 3/1/23. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: Fire clearance was received on 3/7/23. Applicant states that the fire inspector did not require for her to install a fire pull alarm This is a two story, four bedrooms and two bathrooms home and upstairs area will be off-limits to the day-care children. There is a gate at the bottom of the stairs making upstairs area inaccessible. There is a master bedroom downstairs that is made inaccessible by the use of a child proof door knob cover. Closets are made inaccessible by the use of child proof door knob covers. Care and supervision will be provided in study room (day care room), living room/dining room, kitchen and downstairs bathroom. There is no fireplace in the home. LPA observed in the day care room; children size furniture, safe toys, and books for the children. There is a high chair and a parents board. There is a flat screen television mounted onto the day care room wall and another television mounted onto the living room wall. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BENITEZ-LOPEZ, MARTHA FAMILY CHILD CARE	FACILITY NUMBER: 155620147
	VISIT DATE: 03/22/2023

NARRATIVE

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Children will nap in the day care room on mats. Infants will nap on mats. Applicant understands she is to supervise children at all times.
Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
Preventative Health and Safety without Prevention of Lead exposure certification was completed on 9/18/22.
Knives are stored inside a kitchen drawer that is made inaccessible by the use of a child proof magnetic lock. Medications are stored inside a top kitchen cabinet and others are stored in the inaccessible pantry and hallway closet. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof magnetic lock.
Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
There are no bodies of water in the home or premises.
There is a dog that is kept on the fenced side run of the home. There are two cats that are kept upstairs. There are two birds that are kept inside a cage that is kept upstairs. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
Applicant states there are no firearms or ammunition in the home or premises. Poisons are kept locked inside a Tuff-Shed that is located in the backyard.
Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
Applicant states she will be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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-LOPEZ, MARTHA FAMILY CHILD CARE	FACILITY NUMBER: 155620147
	VISIT DATE: 03/22/2023

NARRATIVE

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Fenced backyard has a large dirt area for the day care children.
SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on 1/27/22. Applicant’s assistant completed the training on 5/3/21.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:00 AM to 5:30 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Provisional License for a Large Family Day Care Home capacity of 14 children ages under 18 years will be issued for 90 days, pending receipt of the Preventive Health and Safety Training certification. Provisional license will be effective 3/23/23.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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