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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412230
Report Date: 02/17/2023
Date Signed: 02/17/2023 12:27:14 PM

Document Has Been Signed on 02/17/2023 12:27 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MAYER FAMILY CHILD CAREFACILITY NUMBER:
197412230
ADMINISTRATOR:MAYER, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 285-5077
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
02/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Michelle MayerTIME COMPLETED:
12:41 PM
NARRATIVE
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On 02/17/23, Licensing Program Analysts (LPA’s) Justin Dorsey and Kristina Diaz conducted a case management inspection at the home. Upon LPA’s arrival, 3 children were present with the licensee and staff #1.

During the visit LPA’s issued a citation for conduct Inimical due to the licensee’s behavior with RM and staff. Facility will be cited a Type A Citation Conduct Inimical 1596.885(c). Please see LIC809-D.

Upon receipt of a Type A deficiency, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

An exit interview was conducted, and a copy of this report was read and provided to the licensee on this date, along with a copy of her appeal rights.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/17/2023 12:27 PM - It Cannot Be Edited


Created By: Justin Dorsey On 02/17/2023 at 10:11 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 02/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2023
Section Cited
HSC
1596.885(c)

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Conduct Inimical: Licensee Michelle Mayer engaged in conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California. This requirement was not met as evidence by:
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Licensee shall submit a written statement to the department that she understands the department’s rules and regulations no later than 02/24/23.
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Based on conversations with the licensee a citation for conduct Inimical was issued due to the licensee’s behavior with RM and staff, which posed an immediate risk to the health and safety of 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.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023


LIC809 (FAS) - (06/04)
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