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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411654
Report Date: 08/04/2022
Date Signed: 08/04/2022 04:05:01 PM


Document Has Been Signed on 08/04/2022 04:05 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:BENTON FAMILY CHILD CAREFACILITY NUMBER:
197411654
ADMINISTRATOR:BENTON, SUSANA BENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 737-1757
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:14CENSUS: DATE:
08/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Licensee, Benton FaustaTIME COMPLETED:
04:30 PM
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On 8/4/2022 Licensing Program Analyst (LPA) Dalicia Adkins conducted a case management visit and met with licensee. There were 6 children present and no other adults.

During today's visit LPA provided licensee with technical assistance; operation of family child home and safe sleep practices.

During case management visit LPA observed soft toy attached to crib. LPA discussed Infant safe sleep practices, licensee removed the soft toy from the crib. LPA provided licensee with PIN 20-24 CCP- new safe sleep regulation 102425. Licensee was directed to visit CCLD website to gather more information about safe sleep practices. LPA discussed Individual Sleeping Plan LIC 9227, LPA provided a copy to licensee. LPA advised licensee to complete form for all infants up to 12 months of age. Advisory note given.
LPA advised licensee to maintain a more organized and orderly environment for children in care. LPA advised licensee to complete Community Care Licensing Orientation for Facility Child Care Homes. LPA provided licensee with the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources. LPA referred licensee to Resource and Referral for additional resources. Advisory notes given.
Exit interview conducted. LPA reviewed this report and advisory notes with licensee. Notice of site Visit Given and must be posted for 30 days.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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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