198006582-5-6-2021-33-CC-CGUA-C37V42-20210520160533

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198006582
Report Date: 05/06/2021
Date Signed: 05/06/2021 03:42:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/18/2021 and conducted by Evaluator Judy Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20210318163003

FACILITY NAME:	BENAVIDES FAMILY CHILD CARE		FACILITY NUMBER:	198006582
ADMINISTRATOR:	BENAVIDES, ANGELICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 914-6115
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91740
CAPACITY:	14	CENSUS: 14	DATE:	05/06/2021
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Angelica Benavides		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff pushed child.
Staff mishandled child.
Staff yelled at child.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Judy Mora contacted the facility via telephone to conclude the investigation for the complaint allegations listed above. Findings were delivered via telephone due to COVID-19 and pre-cautionary measures. LPA Mora identified herself and spoke to Licensee Angelica Benavides. LPA discussed the purpose of the call. The call was then transferred to Facetime. Licensee's husband, John Benavides and Licensee's mother, Maria Cuevas were also present during the inspection. LPA visually observed 14 children present at 3:20 PM.

During the course of the investiagtion, LPA obtained a copy of the facility roster, interviews were conducted with children, the Licensee, Licensee's husband and other witnessess. LPA also obtained a copy of a police report from Glendora Police Deaprtment. During the course of the interviews there were no statements made to corroborate with the above allegations. There was also no information from the Glendora PD to further support the allegations. Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

*REPORT CONTINUES ON NEXT PAGE

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20210318163003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BENAVIDES FAMILY CHILD CARE	FACILITY NUMBER: 198006582
	VISIT DATE: 05/06/2021

NARRATIVE

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An exit phone interview has been conducted with Licensee Benavides. A copy of this report has been signed by LPA Mora. This report along with the Appeal Rights will be e-mailed to the Licensee, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A hard copy of this report and the Appeal Rights will be mailed out to the Licensee who agrees to sign the bottom of each page of the 9099 and return the originals to LPA Mora in-person or via U.S. Mail. The Notice of Site Visit is also being sent via email. Notice of Site Visit must be posted for 30 days failure to do so will result in an immediate civil penalty of $100.

*END OF REPORT

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

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