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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700245
Report Date: 05/05/2022
Date Signed: 05/05/2022 09:59:49 AM

Document Has Been Signed on 05/05/2022 09:59 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BURRELL-BENTLEY FAMILY CHILD CAREFACILITY NUMBER:
367700245
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Latoya Burrell-BentleyTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Thompson-Miller met with Applicant, LaToya Burrell-Bentley, who guided analyst on a tour of the facility for a Prelicensing Correction Inspection.

LPA verified the following:
1. Backyard spa has some locks to be secured to the spa so as to not allow any access to the inside of the spa.****LPA verified spa has locks to secure access.
2. Spa motor to be inaccessible to children while outside****LPA verified spa motor is inaccessible (wooden fence).
3. Air Conditioner unit in accessible****LPA verified has a cover.
4. Window cords to be inaccessible****LPA verified window cords are inaccessible (up high, tied)
5. Backyard wooden fence has nails to be inaccessible and replace some wooden fence planks.****LPA verified nails have been removed.
6. Garage internet box to be inaccessible****LPA verified internet box is inaccessible (covered)
7. Stairs require a gate.****LPA verified stairs have a gate.

Applicant ready for licensure.
Exit interview conducted and a copy of this report was read and provided to Applicant Latoya Burrell-Bentley.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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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