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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840780
Report Date: 09/30/2026
Date Signed: 09/30/2026 12:58:58 PM

Document Has Been Signed on 09/30/2026 12:58 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BENNETT FAMILY CHILD CAREFACILITY NUMBER:
364840780
ADMINISTRATOR/
DIRECTOR:		BENNETT, ROCHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 694-4456
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/30/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On September 1, 2026, at approximately 10:30 am, Licensing Program Analyst (LPA) Annelise Villa arrived at the facility to conduct a case management inspection. LPA was greeted through a metal screen door by Adult #1, who stated there were no daycare children at the home. LPA called Licensee who stated there were no daycare children in care today. Per Licensee, the closure was reported to the Palmdale Regional Office.

LPA stated the purpose of the inspection is to review the Confirmation of Removal Letter for Adult #2. The letter states Adult #2 must be removed from the facility because their criminal record exemption was denied. Adult #1 stated Adult #2 was currently inside the home. LPA spoke to Adult #2 who stated Licensee never spoke in detail about the fingerprint clearances or the removal order. During separate interviews, Licensee and Adult #2 stated he returned to the facility on 9/29/2026. This is a Type A citation. Please see LIC 809-D for details.

LPA Villa explained the criminal record exemption denial means the individual may not work in, reside in, or be present at any facility licensed by the Department and must be removed from the facility immediately. LPA Villa also explained that the Confirmation of Removal Notice must be signed and returned within five days of receipt. During annual inspection on July 1, 2026, LPA reviewed and provided LIC 995E and LIC 301E for adult resident confirmation of removal for Adult #2. LPA discussed the nature of the removal with Licensee, who stated she understood.

Continued on LIC 809-C
Mariela Ramon
Annelise Villa
DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BENNETT FAMILY CHILD CARE
FACILITY NUMBER: 364840780
VISIT DATE: 09/30/2026
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A copy of the Confirmation of Removal for Adult #2 was provided to Licensee on 9/30/2026. The Exemption Denial Letter addressed to the licensee and the Exemption Denial Letter addressed to Adult #2 were also provided.

Licensee shall provide a copy of any Type A deficiency to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of the Type A report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) this form must be placed in each of the children’s files for verification of the Type A deficiency. Failure to do so will result in a civil penalty being assessed.

Licensee was not available to sign report, a copy was emailed for signature to return to LPA. A notice of site visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2026 12:58 PM - It Cannot Be Edited


Created By: Annelise Villa On 09/30/2026 at 12:39 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: BENNETT FAMILY CHILD CARE
FACILITY NUMBER: 364840780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2026
Section Cited
CCR
102370.1(a)(5)

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Criminal Record Exemptions: The Department will notify a licensee to act immediately to remove from the facility or bar from entering the facility any person... ordered to be removed by the Department. This requirement is not met as
evidence by:
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Licensee shall immediately remove Adult #2 from the home, and shall not permit entry until a criminal record exemtion is granted.
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LPA Villa observed Adult #2 inside the licensed family childcare home without a criminal record exepmtion. Licensee was notified of the removal order on 7/1/2026. This is a type A deficiency which poses an immediate risk to the health and safety of 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.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Annelise Villa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2026


LIC809 (FAS) - (06/04)
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