197492937-3-22-2022-30-CC-KSTS-CCUQG3-20220325120849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197492937
Report Date: 03/22/2022
Date Signed: 03/22/2022 12:37:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/24/2021 and conducted by Evaluator Shandra Powell

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20211224140739

FACILITY NAME:	MACK FAMILY CHILD CARE		FACILITY NUMBER:	197492937
ADMINISTRATOR:	MACK, LAKEISHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 331-5995
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY:	14	CENSUS: 5	DATE:	03/22/2022
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Lakeisha Mack, Licensee		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Uncleared spouse observed providing care and supervision to children in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shandra Powell conducted a complaint inspection on 03/22/2022. The purpose of the Inspection was to deliver the findings for the above allegation. LPA met with Lakeisha Mack, Licensee 5 children and 2 assistants were present during the inspection.

Based on LPA's interviews, photos received and the licensee admitting that the above allegation is true. The allegation is found to be substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. This poses an immediate risk to the health and safety of children in care an immediate civil penalty of $100.00 will be assessed, California Code of Regulations, Title 22 Regulation are being cited on the attached 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 30-CC-20211224140739

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 197492937
	VISIT DATE: 03/22/2022

NARRATIVE

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Notice of Site Visit form was provided and must be posted for 30 days along with this report citing type A citation. This report must also be provided to parents/guardian of children currently enrolled and parents of newly enrolled children for the next 12 months. Licensee must provide this report along with form LIC 9224 to parents acknowledging receipt of licensing report.

This must be provided within the next business day or upon return. The completed form LIC 9224 shall be filed in children's file. An exit interview conducted, copy of report provided. Appeals rights provided and explained.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

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Control Number 30-CC-20211224140739

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 197492937
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/22/2022 Section Cited CCR 102370(d)(1)	1 2 3 4 5 6 7	Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 prior to working, residing or volunteering in a licensed home,	1 2 3 4 5 6 7	Spouse not allowed to return to facility until Criminal Record Clearance has been cleared.
	8 9 10 11 12 13 14	shall obtain a California clearance or a criminal record exemption as required by the Department...The requirement is not met by evidence of interviews, photos and licensee.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

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