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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492937
Report Date: 10/31/2022
Date Signed: 10/31/2022 03:42:28 PM


Document Has Been Signed on 10/31/2022 03:42 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: 7DATE:
10/31/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Lakeisha Mack, LicenseeTIME COMPLETED:
03:49 PM
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On 10/31/2022, Licensing Program Analyst (LPA) Shandra Powell conducted a case management inspection to the above facility. At the initial start of the visit LPA met with Assistant Veronica Rodriguez, 3 children were present. Assistant gave LPA a tour of the home inside and out. Licensee joined inspection about 10 minutes into inspection. Licensee Mack and Assistant Roe both came into home with 4 additional children. LPA discussed the purpose of the visit with licensee. There were 7 children in care at this time of the inspection with licensee and two assistants.

On 09/01/2022 a letter of Exemption Denial for Andrea Doyle licensee's Husband was created by Care Provider Management Bureau (CPMB) and was received in the El Segundo Regional Child Care Office. The licensee stated she has received the Exemption Denial Letter and a appeal for the exemption is in process. Per licensee, her husband does not come to the child care home and is not involved with the child care children. LPA did not observe licensee husband Andrea Doyle to be present at the facility at the time of the inspection.

LPA Powell reminded licensee that all adults living in or having access to day care children in the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children.

A Notice of Site Visit and Appeal Rights were provided and exit interview conducted with the licensee.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2022
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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