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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300274
Report Date: 08/30/2022
Date Signed: 08/30/2022 11:10:12 AM

Document Has Been Signed on 08/30/2022 11:10 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:JONES-BENNETT FAMILY CHILD CAREFACILITY NUMBER:
336300274
ADMINISTRATOR:JONES-BENNETT,SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 351-2766
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 6DATE:
08/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Susana Jones-BennettTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility to conduct a visit for a different purpose, however, during the visit, LPA was informed by Licensee that she does not report any unusual Incidences to the department and does not provide ouch reports to the parents of children at her facility.

LPA advised Licensee that this is a violation of the requirements of reporting and any unusual incident must be reported to the department using the form LIC 624B within 7 days of the incident. A phone call must be made to the department within 24 hours and the LIC 624B submitted within 7 days.

Based on the information obtained through interviews it has been determined that Reporting Requirements have not been met by the facility.

Appeal rights were discussed and provided during the exit interview.

An Exit Interview was conducted, A Notice of Site visit was given, and the Licensee understands that it must remain posted for 30 days.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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