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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492937
Report Date: 08/19/2022
Date Signed: 08/19/2022 03:32:22 PM


Document Has Been Signed on 08/19/2022 03:32 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:MACK FAMILY CHILD CAREFACILITY NUMBER:
197492937
ADMINISTRATOR:MACK, LAKEISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 331-5995
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:14CENSUS: 9DATE:
08/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Lakeisha Mack, LicenseeTIME COMPLETED:
03:43 PM
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An unannounced Case Management visit was conducted on this date. Licensing Program Analyst (LPA), Shandra Powell observed Licensee exiting car with 3 School Age children at the initial start of the inspection. LPA announced the purpose of the visit. The purpose of the visit is to complete a walk through of the entire facility and to verify with Licensee and Staff if any uncleared Adults live and or present during child care hours.

Per Licensee, individuals whom live in the home are Licensee, Son, Adopted son and Guardian child. During inspection LPA observed Licensee, one Staff and 9 child care children at facility. Licensee is aware that no individual cannot reside or work in the facility until a full criminal record clearance has been completed and placed on the Guardian website.

During inspection LPA interviewed Staff#1.

Licensee was given the websites and phone number for Guardian to contact regarding any questions regarding Criminal Record Clearance.

Please visit https://guardian.dss.ca.gov or CPMB 1-888-422-5669 or guardian@dss.ca.gov.



Exit interview conducted with the Licensee, Lakeisha Mack. This report must be made available for public review for three years. A Notice of Site visit was posted.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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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