197494395-8-4-2023-58-CC-LSTN-CUDUPA-20230804154512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494395
Report Date: 08/04/2023
Date Signed: 08/04/2023 03:45:25 PM

Document Has Been Signed on 08/04/2023 03:45 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MACK FAMILY CHILD CARE		FACILITY NUMBER:	197494395
ADMINISTRATOR:	ADRIENNE MACK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 625-3211
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	08/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	ADRIENNE MACK, LICENSEE		TIME COMPLETED:	04:01 PM

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On 08/04/2023 at 10:45am, Licensing Program Analyst (LPA) Laticia Thompson, conducted an unannounced annual inspection. LPA met with Adrienne Mack, Licensee who assisted LPA with touring the facility.

The home is a 2 story, consisting of 3 bedrooms and 3 bathrooms. The licensee will provide care for children ages, 30 months to 5 years. Licensee stated she chooses not to care for infants. The operating hours are Monday - Friday 8:00 AM - 11:30 PM. Licensee stated she will have multiple care schedules 8/9am-1pm, 3pm-11pm and 6pm-11pm.

The licensee does not have any children enrolled at this time. Facility was inactive due to construction work for a room addition. Licensee provided an updated facility sketch and a copy of Certificate of Occupancy. The room addition is located on the rear side of the home next to the garage. The room addition is where care will be provided. There is a day care room, bathroom, office, and second kitchen in the is area. Parents will enter and exit through the back gate were care will be provided. When entering through the back gate there is a fully fenced grass yard area where children will play.

Licensee has all required postings located in an area that are visible to parents entering the facility. Licensee has a binder with blank documents required for children and staff records.

All areas identified on the facility sketch were toured both indoors and outdoors.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MACK FAMILY CHILD CARE	FACILITY NUMBER: 197494395
	VISIT DATE: 08/04/2023

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Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Napping equipment, arts, crafts and learning material are located in the closet of the day care area. Per Licensee the isolation area is located in the family room. LPA observed that facility does have a combination carbon monoxide smoke detector in operable condition. The 2A10-B:C fire extinguisher was purchased on 10/11/2022.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, will be inaccessible to children and stored in cabinets that have safety latches.

The Licensee will provide food and snacks. Parents will provide food for children with allergies.

All kitchen areas/food preparation areas and food storage areas were observed to be clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects and rodents.

Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. LPA Thompson advised Licensee that the children need to be within the direct care and supervision, including visual supervision at all times. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is adequate shade in the play yard. Licensee will ensure that there will be outdoor drinking water available.

There are no bodies of water on the premises.

Applicants state that medication will be stored in the locked office cabinet. LPA observed a First Aid Kit with required supplies.

The family room will be used as an ill/isolation area.

There were no deficiencies observed during today’s visit. --Page 2 of 4

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MACK FAMILY CHILD CARE	FACILITY NUMBER: 197494395
	VISIT DATE: 08/04/2023

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage ahttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

--Page 3 of 4

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MACK FAMILY CHILD CARE	FACILITY NUMBER: 197494395
	VISIT DATE: 08/04/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Adrienne Mack.

--Page 4 of 4

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC809 (FAS) - (06/04)

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