<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494218
Report Date: 06/28/2023
Date Signed: 06/28/2023 11:51:25 AM


Document Has Been Signed on 06/28/2023 11:51 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:BENSIMON FAMILY CHILD CAREFACILITY NUMBER:
197494218
ADMINISTRATOR:BENSIMON, NATHALIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 801-7103
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:14CENSUS: 10DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:SANDRA REA-ORNELAS, ASSISTANTTIME COMPLETED:
12:30 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 06/28/2023, Licensing Program Analyst (LPA), Lisa Clayton conducted an unannounced Annual inspection and was greeted by FCCH fingerprint cleared assistants Sandra Rea-Ornelas and Noelia Rea-Ornelas. LPA observed 10 children in care today, being supervised and cared for appropriately. Operating hours are Monday – Friday, 8am – 5:30pm. The FCCH provides breakfast, lunch, dinner, and am/pm snacks. Capacity as specified on the license is being maintained.

LPA toured the home inside and outside for a Health and Safety inspection. The single-family home consists of the following: 3 bedrooms, 2 bathrooms, living room/dining room, kitchen, attached garage, laundry room/back porch and fenced back yard.

The ON-LIMIT areas are as follows: Living room/dining room (daycare room), bedroom #1 (napping room), bathroom #1, kitchen (to access the backyard only), laundry room/back porch (to access the backyard only) and fenced back yard.

The OFF-LIMIT areas are as follows: Bedrooms #2 and #3 and bathroom #2, all of which are made inaccessible by locked doors, child safety gates and supervision.

There is a fully charged fire extinguisher. The facility has a working carbon monoxide/smoke detector in the daycare room, and smoke detector in the napping room. The facility has adequate heating and ventilation for safety and comfort. There are no stairs in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA Clayton confirmed the phone number is (310) 801-7103.

Per Assistant Sandra, there are no firearms in the home. There are no swimming pools, ponds or other bodies of water on the property. Any detergents, cleaning compounds, medication, poisons and other hazardous items are made inaccessible to children.

Assistant Sandra ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BENSIMON FAMILY CHILD CARE
FACILITY NUMBER: 197494218
VISIT DATE: 06/28/2023
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
26
27
28
29
30
31
32
LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment, individual feeding plan, and Infant Needs and Services Plan.

Licensee’s and both assistants pediatric CPR/First Aid are current and expire in 2025 and Mandated Reporter Training expires in 2025. A review of records indicates that Licensee and staff have immunization records on file for TB, Flu, pertussis (Tdap/Dtap) and MMR.

Incidental Medical Services (IMS) are being provided. LPA Clayton provided a copy of the IMS Plan Sample and instructed Assistant Sandra to have the licensee forward a completed IMS Plan to the department no later than 07/05/2023. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Assistant Sandra 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.

LPA Clayton reminded the assistant of the sleep regulations, and provided the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Assistant Sandra 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.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BENSIMON FAMILY CHILD CARE
FACILITY NUMBER: 197494218
VISIT DATE: 06/28/2023
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
26
27
28
29
30
31
32
Upon arrival at the FCCH, LPA Clayton was advised by Assistant Sandra, that Licensee is away from the home and will be returning on Friday 06/30/2023. LPA Clayton spoke with licensee via phone, and LPA Clayton reminded Licensee Bensimon that per Title 22 Regulation 102417(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

A Technical Violation was cited today, Per Title 22, Division 12, Chapter 3, of the California Code of Regulations.

An exit interview was conducted, this report was read, signed by and a copy was given to assistant Sandra Rea- Ornelas. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3