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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019544
Report Date: 09/22/2020
Date Signed: 09/23/2020 12:44:39 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: 10DATE:
09/22/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Sandra Benitez, licenseeTIME COMPLETED:
11:45 AM
NARRATIVE
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Due to COVID19 and the Department of Public health (DPH) guidelines of social distancing, this inspection was conducted virtually using FaceTime application.
Licensing Program Analyst (LPA) Alicia Mooberry conducted a Case Management tele-inspection in Spanish. LPA met with Sandra Benitez, Licensee, who guided analyst on a tour of the facility. Also present during this inspection, was Tere Escobedo, assistant. LPA observed 10 children (9 preschoolers and 1 infant) present during the tele inspection.

The purpose of this tele-inspection is to follow-up on and incident reported to the department on 2/18/20 in which an investigation took place. Based on interviews conducted during this investigation, it was disclosed that Individual #1, Erick Chajon touched Child #1 on their private area. This is conduct which is inimical to health, morals, welfare, and safety of an individual in or receiving services from the facility, or the people of the state of California.

Due to Licensee’s conduct, the following deficiency listed on the attached LIC 809 (deficiency page) is being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form via email during this tele-visit. A copy of the Parent Notification Requirements was also provided to the Licensee.

Exit interview was conducted virtually via FaceTime application with , Licensee, including, but not limited to Appeal Procedures and Initial Appeal Rights. A copy of this report will be provided to the Licensee via email with a “Read Receipt” notification to confirm that the Licensee did indeed receive a copy.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198019544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/22/2020
Section Cited

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1596.885 Denial, suspension or revocation of license, registration, or special permits; grounds - (c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.
This requirement is not met as evidenced by:
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Based on interviews conducted during this investigation, it was disclosed that Individual #1, Erick Chajon touched Child #1 on their private area.

This poses an immediate risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2020
LIC809 (FAS) - (06/04)
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