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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494814
Report Date: 11/16/2021
Date Signed: 11/17/2021 10:41:01 AM

Document Has Been Signed on 11/17/2021 10:41 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BENABU FAMILY CHILD CAEWFACILITY NUMBER:
197494814
ADMINISTRATOR:BENABU, SHIRANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 671-9903
CITY:TARZANASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
11/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Shirani BenabuTIME COMPLETED:
04:39 PM
NARRATIVE
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On 11/16/2021 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced visit to conduct and inspection for bodies of water (swimming pool). LPA observed 2 adults (licensee and assistant) and 10 children. LPA discovered that one adult did not have a criminal background clearance. Licensee stated she was unaware that a criminal background was required. Licensee stated assistant has been working at the facility for approximately three weeks. Licensee also stated a second assistant just left the facility and is currently unsure if she has had a criminal record clearance.

LPA advised licensee that the uncleared adult must leave the premises and can not be allowed to care for children until a back ground clearance has been processed. LPA advised licensee she is required to reduce her capacity to a small family child care due to not having an assistant.

LPA inspected the pool area. There are two mesh fencing separating the facility from the pool. The mesh fencing is sturdy and there are no visual damages or alteration. The gate swings away from the body of water, self closing, latches and has a lock which requires a key for unlocking. LPA advised licensee to remove the keys from the lock to prevent children from accessing. The windows facing the pool has metal bars attached to prevent access.



Licensee is cited for the following deficiencies (see 809D):

Criminal Record Clearance
Out of ratio
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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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Document Has Been Signed on 11/17/2021 10:41 AM - It Cannot Be Edited


Created By: Laticia S Thompson On 11/16/2021 at 03:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BENABU FAMILY CHILD CAEW
FACILITY NUMBER: 197494814

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/16/2021
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review ...shall prior to working, residing, or volunteering in a licensed facility(1) Obtain a California clearance or a criminal record exemption as required by the Department.This requirement was not met as evidence by
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Licensee will provide proof of live scan to LPA by 11/19/2021 and will not allow any assistant to provide care for children unless the adult has a criminal background clearance.
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Based on LPA's observation of an assistant caring for chldren that does not have a criminal background clearenace which poses an immediate Health & Safety risk to children in care
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Type A
11/16/2021
Section Cited
CCR102416.5(e)

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102416.5 Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care.This requirement was not met as evidence by

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Licensee agrees to comply with small family child care requirements until she has an assistant that has met all licensing requirements.
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Based on LPA's observation of licensee caring for 10 children age 3-5years of age.which poses an immediate Health & Safety risk to 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:Peter Flores
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2021


LIC809 (FAS) - (06/04)
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