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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500279
Report Date: 08/24/2021
Date Signed: 08/24/2021 02:44:39 PM

Document Has Been Signed on 08/24/2021 02:44 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:BENSON, ROBYNFACILITY NUMBER:
574500279
ADMINISTRATOR:ROBYN BENSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 304-8490
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
08/24/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Robyn BensonTIME COMPLETED:
02:25 PM
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 Licensing Program Analyst (LPA) Amy Silva met with Licensee, Robyn Benson for an unannounced random annual inspection. There were six children present during the visit. Off-limit areas include:both bedrooms, laundry room and garage. Licensee acknowledged that children may never enter these off-limit areas. Hours of operation are 7:00am to 5:00pm and other hours as arranged.

There are no "bodies of water" at this home. Licensee states there are no weapons or firearms in the home. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fire extinguisher, carbon monoxide detector and smoke detector meets regulations. Smoke detector and carbon monoxide detector were tested at 1:15 pm and were found to be in working order. Safe toys and play equipment are observed. LPA reviewed staff records and six child files. All file contained the required documents.

LPA observed a current roster of the enrolled children, a fire drill log and all other required documents. LPA observed current CPR/First Aid certificates which expires August 2022. LPA observed Mandated Reporter training is current and will expire July 2022.

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.


Report continues on 809C



SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Amy Silva
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
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: 574500279
VISIT DATE: 08/24/2021
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LPA provided and discussed the Safe Sleep in Child Care regulations and PIN, and Effects of Lead Exposure brochure.

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection. Notice of site visit was provided and posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Amy Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
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