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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500598
Report Date: 06/19/2023
Date Signed: 06/19/2023 02:52:29 PM

Document Has Been Signed on 06/19/2023 02:52 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BENSON, ROBYNFACILITY NUMBER:
574500598
ADMINISTRATOR:BENSON, ROBYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 304-8490
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Robyn BensonTIME COMPLETED:
03:00 PM
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On June 19, 2023, Licensing Program Analysts (LPA) Jennie Tedlos and Lauren Scott conducted an unannounced 1 Year required inspection and met with Licensee, Robyn Benson. LPAs observed 7 children supervised by Licensee. Criminal record clearances have been verified. Facility fees were reviewed and are current. Licensee stated there are no new residents in the home since licensure. Licensee operation hours are Monday- Friday: 7:00 AM- 5:00 PM and does not provide overnight care.

LPAs and Licensee toured the facility during the inspection. Off limit areas are both bedrooms and the laundry room. At time of inspection, licensee requested to make one of the bedrooms/storage room on limits. LPAs toured the room. The bedroom/storage room is now on limits. The back playroom/bedroom is now off limits. Facility sketch was updated. The new off limits are Bedroom #1 and Master Bedroom. The backyard is fenced. There are no weapons in the home.

LPAs conducted record reviews during the inspection. Five child files, and the licensee's file was reviewed. Licensee's mandated reporter training expires 1/25. LPAs discussed mandated reporter training with the Licensee. Licensee understands Mandated Reporter Training is to be completed every two years. Mandated reporter training can be accessed at www.mandatedreporterca.com. CPR/First Aid certification was reviewed for Licensee. Certification expiration date is 4/24. LPAs discussed regulations for fire drill logs. LPAs observed that there were no hazardous items accessible to children. LPAs observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe.

This facility does not provide Incidental Medical Services- IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA Information 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

Report continued on to 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BENSON, ROBYN
FACILITY NUMBER: 574500598
VISIT DATE: 06/19/2023
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LPAs discussed the safe sleep regulations with Licensee, Robyn Benson, 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. LPAs also informed 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.


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 [email protected]. 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.

Exit interview conducted and report was reviewed with the Licensee, Robyn Benson. A notice of site visit was posted by LPAs and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


In the areas that were evaluated, no deficiencies were cited during today's visit.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC809 (FAS) - (06/04)
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