<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198019959
Report Date: 04/04/2023
Date Signed: 04/04/2023 04:44:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2023 and conducted by Evaluator Susann Sanchez
COMPLAINT CONTROL NUMBER: 54-CC-20230328130207
FACILITY NAME:MACK FAMILY CHILD CAREFACILITY NUMBER:
198019959
ADMINISTRATOR:MYESHA MACKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 812-3674
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: DATE:
04/04/2023
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Myesha Mack, LicenseeTIME COMPLETED:
05:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is operating over capacity.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 On 4/04/23 at 2:25 PM Licensing Program Analyst (LPA) Susann Sanchez conducted a 10-Day complaint investigation visit. LPA knocked serval times and did hear children but there was no response. LPA called Licensee serval times and stated that she is on her way. Licensee Myesha Mack arrived at 2:45pm and let LPA into the facility. Licensee gave LPA a tour of the facility. LPA observe 10 children.

Upon arrival to the facility, LPA observed 10 children with the Licensee assistant. Per Licensee, Assistant was alone with 10 children from 2:00pm to 2:45pm. Reporting party stated was facility was operating out of capacity on various days throughout the month of February. During inspection, Licensee stated that she was over capacity twice in February. Licensee stated that she does not remember the exact date she was over capacity around February holidays.

Based on the LPA observations, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22 102416.5(a) Staffing Ratio and Capacity, is being cited on the attached LIC 9099-D.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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 4
Control Number 54-CC-20230328130207
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MACK FAMILY CHILD CARE
FACILITY NUMBER: 198019959
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2023
Section Cited
CCR
102416.5
1
2
3
4
5
6
7
Staffing Ratio and Capacity- The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidenced by observation and interview. LPA entered the facility with Licensee at 2:45pm and there was
1
2
3
4
5
6
7
Per Licensee, she will talk with the parents and work on the childrens schedule to ensure that she does not go over her capacity. Licensee will submit a copy of the new schedule to LPA by Wednesday 04/05/23. LPA explained the department TSP program and wants LPA to send a referral.
8
9
10
11
12
13
14
10 children alone with Licensee assistant. Licensee stated that she was over capacity twice in the month of February. This poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 54-CC-20230328130207
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MACK FAMILY CHILD CARE
FACILITY NUMBER: 198019959
VISIT DATE: 04/04/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

Exit interview was conducted with Licensee Myesha Mack. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4