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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622592
Report Date: 06/07/2023
Date Signed: 06/07/2023 01:09:53 PM

Document Has Been Signed on 06/07/2023 01:09 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ARIAS, SILVIA/BENITEZ, MELANIE & ALEJANDROFACILITY NUMBER:
343622592
ADMINISTRATOR:SILVIA A./MELANIE & ALEJANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 903-7651
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
06/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
01:20 PM
NARRATIVE
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On June 07, 2023, an unannounced annual/random inspection was made today by LPA Barragan. Present at time of inspection were licensee, her assistant, two of her children and 10 day care children. LPA Barragan spoke with Alejandro Benitez, Assistant and Arias Silvia, Licensee

LPA tour of the home was conducted the inspection, inside and outside, as shown on the facility sketch is conducted. Licensee states there are no weapons or firearms in the home. There was no spas or pools in the home. LPA's observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. There was a fireplace in the home, but it is inaccessible to the children. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations. Currently, Licensee does have 4 dogs and 1 cat. The Licensee stated that she separates the dogs from the children. The Licensee was reminded to ensure safety and appropriate supervision if the dogs are ever near the children. There are stairs in the home and the Licensee did not have a gate in front of the stairs to barricade access to children from going up the stairs. Photo's were taken of this. One citation is being administered due to this deficiency. Toys and play equipment that were observed appeared to be safe. There is a working telephone. Adequate supervision is being provided during this inspection. Children are supervised when outside in any unfenced play area. There was 1 infant under 12 months old present.

The home is a 2 story, 6 bedroom and 3 bathroom house. Off limit areas include: Entire second floor and garage. LPA explained about obtaining $300,000 liability insurance. She understands that until a policy is obtained, she must use the affidavit. LPA provided a copy of affidavit to the applicant.

Pediatric CPR/FA is current with expiration date of 03/2024 for the Arias Silvia, Licensee. A child roster is maintained. Fire and disaster drills have been conducted every six months and documented. (The last fire drill was 06/23.) 10 child's records were reviewed during this inspection.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Eduardo Barragan
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ARIAS, SILVIA/BENITEZ, MELANIE & ALEJANDRO
FACILITY NUMBER: 343622592
VISIT DATE: 06/07/2023
NARRATIVE
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LPA's discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 7 AM to 5:30 PM; Monday thru Friday and other hours as arranged. Licensee states she does not transport children.

Alejandro Benitez, Assistant and Arias Silvia, Licensee were 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 discussed the safe sleep regulations with licensee Alejandro Benitez, Assistant and Arias Silvia, Licensee and discussed 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. LPA also informed licensee Alejandro Benitez, Assistant and Arias Silvia, 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. LPA Barragan printed out safe sleep regulations and discussed/provided the regulations with the Licensee. LPA also provided the Licensee with LIC 9227 due to the children not having this form in their file. LPA also spoke with the licensee about documenting 15 minutes the children's sleep times. Two citation is being administered due to these deficiency's.


LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com .Alejandro Benitez, Assistant, mandated reporter training is good until 03/24 and Arias Silvia, Licensee mandated reporter training is good until 03/24.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Eduardo Barragan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ARIAS, SILVIA/BENITEZ, MELANIE & ALEJANDRO
FACILITY NUMBER: 343622592
VISIT DATE: 06/07/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. 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 .No children currently on medication.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regard to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

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.

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.

Three type B citations are being administered during this visit.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Alejandro Benitez, Assistant and Arias Silvia, Licensee.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Eduardo Barragan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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Document Has Been Signed on 06/07/2023 01:09 PM - It Cannot Be Edited


Created By: Eduardo Barragan On 06/07/2023 at 12:19 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ARIAS, SILVIA/BENITEZ, MELANIE & ALEJANDRO
FACILITY NUMBER: 343622592

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on oobservation, the licensee did not comply with the section cited above due to there not being a gate barricating the stairs. LPA Barragan obtaining photos of this, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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Licensee will submit photos to LPA Barragan that there is a gate posted through email by 07/07/23. Email: Eduardo.Barragan@dss.ca.gov
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above due to the Licensee not having a sleep plan, which poses a potential health, and safety risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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The Licensee stated that she will ensure she gets a sleep plan for all children by the end of today (06/07/23.)
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:Natalie Dunaway
LICENSING EVALUATOR NAME:Eduardo Barragan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/07/2023 01:09 PM - It Cannot Be Edited


Created By: Eduardo Barragan On 06/07/2023 at 12:19 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ARIAS, SILVIA/BENITEZ, MELANIE & ALEJANDRO
FACILITY NUMBER: 343622592

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above due to the Licensee had not been updating sleep times since 03/23, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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The Licensee stated that she will ensure she starts documenting infant names and sleeping date/times every 15 minutes.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Eduardo Barragan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


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