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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197412230
Report Date: 12/20/2022
Date Signed: 03/29/2023 03:53:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2022 and conducted by Evaluator Justin Dorsey
COMPLAINT CONTROL NUMBER: 12-CC-20220512090217
FACILITY NAME:MAYER FAMILY CHILD CAREFACILITY NUMBER:
197412230
ADMINISTRATOR:MAYER, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 285-5077
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 12DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Michelle MayerTIME COMPLETED:
01:49 PM
ALLEGATION(S):
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Inappropriate interaction between day care children.
INVESTIGATION FINDINGS:
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On 12/20/22, Licensing Program Analysts (LPA's) Justin Dorsey and Andrea Pittman conducted an unannounced complaint inspection to deliver findings on the above allegation. An office meeting was conducted in the Palmdale RO today 3/29/2023 to meet with Michelle Mayer to deliver an amended report and discuss the amended findings from substantiated to unsubstantiated. The meeting was conducted today by Regional Manager Herring and Justin Dorsey.

During the course of the initial investigation, Investigation Branch (IB) Investigator Olivia Spindola conducted interviews with parties and gathered documents related to the complaint. It is determined that the aforementioned allegation of inappropriate interaction between child #1 and child #2 has been updated to reflect unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the facility is not providing a safe and healthful environment, Therefore the above allegation is Unsubstantiated.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 12-CC-20220512090217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MAYER FAMILY CHILD CARE
FACILITY NUMBER: 197412230
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/27/2022
Section Cited
CCR
102417(a)
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102417 Operation of the Family Child Care (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. The requirement is not met as evidenced by:
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Per licensee she will write a wriiten plan on how she will provide care and supervision to children in care by POC due date 12/27/22.
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Based on IB findings the propper care and supervision was not being upheld at the home. This is a type A deficiency that poses an immediate Health, Safety and Personal Rights risk to 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20220512090217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MAYER FAMILY CHILD CARE
FACILITY NUMBER: 197412230
VISIT DATE: 12/20/2022
NARRATIVE
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A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted, a copy of this report, and a notice of site visit were provided to Licensee Michelle Mayer.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3