Benson, Dolores Family Child Care Home

102418(g) · Immunizations (g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

Deficient Practice Statement 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. POC Due Date: 12/23/2025

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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

Deficient Practice Statement 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. POC Due Date: 12/23/2025

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102370(d) · Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility

Deficient Practice Statement 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. POC Due Date: 02/25/2023

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102416.1(a)(10) · Personnel Records (a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

Deficient Practice Statement 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. POC Due Date: 03/10/2023

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102418(g)(1) · Immunizations (g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

Deficient Practice Statement 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. POC Due Date: 03/10/2023

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102421(a) · Child's Records (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

Deficient Practice Statement 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. POC Due Date: 03/10/2023

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102369(b)(9) · Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.

Deficient Practice Statement 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. POC Due Date: 03/17/2023

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102416.2(a)(2) · (a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

Deficient Practice Statement 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. POC Due Date: 03/10/2023

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