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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818524
Report Date: 03/23/2022
Date Signed: 03/23/2022 12:49:54 PM


Document Has Been Signed on 03/23/2022 12:49 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:MACEDO FAMILY CHILD CAREFACILITY NUMBER:
334818524
ADMINISTRATOR:LILLY MACEDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 805-8902
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:14CENSUS: 13DATE:
03/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Licensee Lilly MacedoTIME COMPLETED:
01:03 PM
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Licensing Program Analyst (LPA) Otsanya Cameron arrived at the facility for the purpose of conducting a case management visit to deliver an amended report previously delivered on 03/21/22. LPA met with Licensee and a census was taken.

LPA Cameron explained and reviewed the amended report with Licensee Lilly Macedo


A Notice of Site visit was issued, along with a copy of this report and the amended complaint report. A previously issued deficiency was cleared during this visit. No deficiencies cited at this time.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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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