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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019544
Report Date: 01/12/2022
Date Signed: 01/12/2022 03:38:37 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: 3DATE:
01/12/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Sandra BenitezTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alicia Mooberry made an unannounced case management visit to the home and met with licensee Sandra Benitez. Case Management visit was required pursuant to 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. The licensee gave a tour or the facility including off limit areas.
Present in the home during this visit were 3 children that included 2 infants. at 2:15pm LPA observed 2 infants, Child #1 and Child #2 napping in the family room in separate cribs. Child #1 and Child #2 were covered with a baby blanket. The infants head was not covered. This poses a potential risk to the health and safety of children in care. Licensee immediately removed the blankets from the crib. All adults present in the home during this inspection are cleared and associated to the facility. All individuals residing in the home were discussed and noted. Licensee maintains facility roster with current information. Licensee CPR/First Aid expires 09/2023. Fire extinguisher and smoke and carbon monoxide detectors are in operable condition. Child files were reviewed and found complete.

Toxins and sharp items in are stored inaccessible to children. LPA did not observe any hazards in the kitchen or bathroom that is used for day care.
Licensee maintains license and other required LIC forms posted in a visible area in the dining room.

LPA informed licensee on the following: keeping in compliance with Title 22 Regulations, criminal record clearances (civil penalties/prior to presence), mandated reporting, incident reporting, supervision, terms of license, and record keeping.
The following deficiency was cited in accordance with California Tittle 22 Regulation in LIC 809D

Exit interview conducted with licensee Sandra Benitez. Appeal rights provided and reviewed.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
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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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: 01/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/12/2022
Section Cited

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(b) Cribs or play yards shall be free from all loose articles and objects.



This requirement is not met as evidenced by:
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LPA observed Child#1 and Child #2 with a baby blanket in the crib while sleeping. Per licensee the infants supervised at all times while they nap.
This poses a potential 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2022
LIC809 (FAS) - (06/04)
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