BENSON, DOLORES FAMILY CHILD CARE HOME

Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 5 children's records. Child C5's file did not contain all required immunizations, which poses a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee has spoken to C5's parent, who has agreed to setting an appointment for this week for C5 to get the required vaccines. Licensee will send proof of C5's required vaccines to LPA Strother by 12/23/25 by email: amy.strother@dss.ca.gov

Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 infants files. L1 did not have current sleep logs for infants C3 and C5 containing date, name, and time of each 15 minute check, which poses a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she will print out sleep logs and start logging sleep checks for C3 and C5 as of today. Licensee will submit one weeks documentation of sleep logs for infants C3 and C5 by 12/23/25, to email: amy.strother@dss.ca.gov

Based on LPA's review of three staff (LS, S1 & S2) at 10:28am which revealed S1 & S2 were missing Employee Rights (LIC 9052). The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would provided LIC 9052 to S1 & S2, and Licensee would submti evidence of the licensing forms signed by S1 & S2 by 03/10/23. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on LPA's review of five children's (C1-C5) records at 10:59am, which revealed C1, C2, C3 & C5's Immunization Records (IR) were not transcribed onto the blue CDPH 286. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would review all the children's records and transcribe all required Immunization Records onto the blue CDPH, and Licensee would submit evidence of the children's transcribed IR on the CDPH 286 by 03/10/23. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on LPA's review of five children's (C1-C5) records at 10:59am, which revealed C1 & C2's records did not contained Licensing forms 995 or 627 that were required to be signed by parents. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would ensure C1 & C2's parents signed either the Licensing form 995 or 627, and the Licensee would submit copies of the signed forms to the Department by 03/10/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on Licensee's statement revealing A1 resided in the home since 01/01/23 and Department records confirming A1 had not obtained an approved criminal record clearance. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would send A1 to get Livescan and Licensee would submit the completed LIC 9163 to the Department by 02/25/23 via email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on the Licensee not furnishing to prove she an updated Application was submitted to notify the Department that A1 resided in the home. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would submit an updated Application (LIC 279) to the Department to reflect A1 moved in the home. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on LPA's review of three staff (LS, S1 & S2) records at 10:28am which revealed S1 & S2's records did not contain a current AB 1207 Mandated Reporter Training certificate. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she S1 & S2 would complete the AB 1207 Mandated Reporter Training module at mandatedreporterca.com, and Licensee would submit current certificate of completion for S1 & S2 by 04/10/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on the Licensee's statement confirming A1 resided in the home and Licensee did not furnish evidence of negative TB clearance for A1. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would ensure A1 obtained evidence of negative TB clearance, and Licensee would submit evidence og A1's clearance to the Department by 03/17/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on LPA's review of three staff (LS, S1 & S2) at 10:28am which revealed LS, S1 & S2's records did not contain proof of immunity against the Influenza. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would obtain required immunization record for LS, S1 & S2, and Licensee would submit the required immunization records to the Department by 03/10/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.