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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008988
Report Date: 07/12/2019
Date Signed: 07/12/2019 12:48:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BENTLEY, TRICIA FCCHFACILITY NUMBER:
483008988
ADMINISTRATOR:BENTLEY, TRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 373-6061
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY:14CENSUS: 11DATE:
07/12/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Tricia BentleyTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) arrived to conduct a case management visit regarding an Unusual Incident which was phone in by the licensee on July 9, 2019. The licensee mailed a copy of the UIR to the licensing office on 7/9/19.

The licensee said that the parent of child C2 notified the licensee on 7/8/19 that on 7/3/19 child C1 made inappropriate verbal comments and in appropriate touching of child C2. The licensee said that she believes that the incident occurred around 1:30pm when she was outside with the children. The licensee said that the younger children were asleep and her assistant was inside with them. The licensee was outside with the older children who were playing. She said that the C1 and C2 were inside of a playhouse and C1 was not letting another child into the play house. The licensee said that she went over to the play house and spoke with C1 to let the child know that the play toys are for sharing and not to exclude anyone. She said that she was in the backyard with the children. She said that it could have happened that day.

The licensee said that after being notified by the parent of C2, she notified parent of C1. Child C1 does not reside in Benicia but would stay with the joint custodial parent on certain days.

The licensee notified CCL within within 24 hours of the incident being reported and submitted the incident to the Sacramento County CPS. The Unusual Incident Report was mailed to the Child Care Rohnert Park Regional Office. LPA Ouye copied the UIR during the site visit.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: BENTLEY, TRICIA FCCH
FACILITY NUMBER: 483008988
VISIT DATE: 07/12/2019
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LPA Ouye received a copy of an Emergency Response Referral Information report from Sacramento County CPS. A cross report to the Benicia Police Department was also done by the Sacramento County CPS.

Based on the investigation of the Unusual Incident Report, Community Care Licensing determines that there was appropriate supervision at the time of the incident and no deficiency will be cited as a result of the incident.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
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