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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006076
Report Date: 12/08/2021
Date Signed: 12/08/2021 11:47:27 AM

Document Has Been Signed on 12/08/2021 11:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BENARD HOME 1FACILITY NUMBER:
306006076
ADMINISTRATOR:BEHLA, BRIJINDERFACILITY TYPE:
735
ADDRESS:11142 WAKEFIELDTELEPHONE:
(310) 612-1611
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 3DATE:
12/08/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH: Licensee Teresa Benard and Administrator Brijinder BehlaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPAs) Albert Marin and Jerome Haley made an announced visit to this facility to conduct pre-licensing inspection and Component III orientation LPAs met with Licensee Teresa Benard and Administrator (AD) Brijinder Behla. LPAs stated the purpose of this visit.

On October 5, 2021, The Orange County Fire Authority granted fire clearance of six ambulatory to this one level structure.

LPAs Marin and Haley toured in the interior and exterior portions of the facility with Ms. Benard, and AD Behla. LPAs observed three clients in care and two staff members during this visit. There were currently four private client’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Hardwired smoke, and carbon monoxide alarms were tested to be operational. Bathrooms were observed to be in good repair. Hot water was measured at 110 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to clients in care. First aid kit was in place. Fire extinguisher was mounted and charged. LPAs observed required posters were in place. For the exterior portion, facility had outside furniture in good repair, and grounds were free of tripping hazards. Side exit doors were free of any obstructions

LPA Marin conducted Component III Orientation with Licensee Benard and AD Behla. .

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

Prelicensing visit and Component III Orientation are now complete. LPA Marin will send a copy of this report to Centralized Applications Bureau for final determination of the application.

LPAs Marin and Haley conducted an exit interview with Licensee Benard ; and copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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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