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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019544
Report Date: 06/29/2020
Date Signed: 07/03/2020 01:58:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BENITEZ FAMILY CHILD CAREFACILITY NUMBER:
198019544
ADMINISTRATOR:SANDRA BENITEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 359-5551
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY:14CENSUS: 2DATE:
06/29/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sandra Benitez, LicenseeTIME COMPLETED:
02:00 PM
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Inspection conducted in Spanish via video using What's App application
Licensing Program Analyst (LPA) Alicia Mooberry conducted an announced Case Management Inspection in order to reinstate operations of Family child care home after inactive status due to licensee testing positive for COVID-19. This inspection was conducted via video using What's App application because of COVID-19 safety guidelines. LPA met with licensee, Sandra Benitez, who guide LPA on a tour of the facility. This is a two story 3 bedroom, 2 bath single family home. Also present in the home were licensee's two children.
LPA observed copy of COVID-19 retest resulting in Negative results (copy sent via email).
LPA reviewed COVID-19 safety precautions and guidelines and provided licensee with self assessment checklist and resources.
LPA observed a door to laundry room lock that was broken leading to the laundry room which holds bleach, laundry detergent and other leaning supplies on low shelves. Licensee will fix the chain lock on the door prior to going active again.

This report will be submitted to LPM Van Oosten for final approval prior to facility resuming operation.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Sandra Benitez, including, but not limited to Provider Rights, Appeal Procedures.


SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2020
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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