<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841327
Report Date: 02/23/2021
Date Signed: 03/19/2021 02:02:34 PM

Document Has Been Signed on 03/19/2021 02:02 PM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BENAVIDES - HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
364841327
ADMINISTRATOR:BENAVIDES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 246-5887
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
02/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Maria Benavides LIcenseeTIME COMPLETED:
10:19 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Steven Montoya amended this report for Case Management inspection conducted on 02-23-2021. On 02-23-2021, Licensing Program Analyst (LPA) Steven Montoya met with licensee Maria Benavides Hernandez. The purpose of the inspection is to conduct a health and welfare check. Licensee is license to provide care and supervision for a Large Family Child Care Home (FCCH) for the capacity of (14) children. There are currently (9) children present at the time of inspection.

Present during the time of this inspection and providing care is licensee, 1 adult son with the 7 children. Licensee residing in the home is license, spouse and Adult son. Per licensee all adults residing in the home have a Criminal Record Clearance. LPA toured areas of the home utilized for Family Child Care to ensure home is incompliance with Community Care Licensing: Title 22 Regulations.

During this inspection, no deficiencies were observed. An exit interview was conducted and a copy of this report was emailed to licensee for signature and return via email. .

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1