198019544-10-26-2021-54-CC-AMOY-C86RRE-20211026131502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019544
Report Date: 10/26/2021
Date Signed: 10/26/2021 01:15:52 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 CARE		FACILITY NUMBER:	198019544
ADMINISTRATOR:	SANDRA BENITEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 359-5551
CITY:	BELL GARDENS	STATE: CA	ZIP CODE:	90201
CAPACITY:	14	CENSUS: 8	DATE:	10/26/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:57 AM
MET WITH:	Sandra Benitez, Licensee		TIME COMPLETED:	01:28 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Visit conducted in Spanish

Licensing Program Analyst (LPA) Alicia Mooberry conducted a Case Management visit to facility to discuss the Stipulation and Waiver and Order dated September 28, 2021. The Stipulation and Waiver and Order was adopted by the Department and became effective October 7, 2021.

LPA met with Sandra Benitez, Licensee, who provided tour of facility. Licensee states she understands the Family Child Care license has been placed on three (3) years probation beginning on 10/07/21.

There were 8 children present on this date. Also present was Gabriela Hinjosa-Reyes, Assistant.

At this visit LPA provided licensee with a signed copy of the Stipulation and Waiver and Order.

LPA reviewed the limitations and conditions of the Stipulation and Order in Spanish

Licensee understands she must remain in compliance with the regulations and statutes governing the operation of a family child care home.

For the duration of the probationary period, licensee understands to provide to a copy of this Stipulation and the Accusation to parents of children in care on

Parents shall sign an acknowledgment (LIC 9224) indicating they have received a copy of the Stipulation and the attached Accusation. This parental acknowledgement shall be maintained in the corresponding child's file and shall be made available to the Department upon request. LPA provided the LIC 9224 Acknowledgement

LPA discussed the exclusion of Erick Chajon from the facility pursuant to the Default Decision and Order issued by the Department on December 10, 2020. LPA verified with licensee that the excluded individual is no longer living in the home. LPA did not observe Erick Chajon in the home on this date. LPA confirmed by LIS that Erick Chajon is not associated to the facility license.

No deficiencies were observed in the areas evaluated during the visit.

Exit interview conducted with licensee Sandra Benitez.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

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

LIC809 (FAS) - (06/04)

Page: 1 of 1