198019959-4-20-2023-54-CC-VCOK-CSUVN5-20230616163433

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019959
Report Date: 04/20/2023
Date Signed: 04/20/2023 10:38:10 AM

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

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20230328130207

FACILITY NAME:	MACK FAMILY CHILD CARE		FACILITY NUMBER:	198019959
ADMINISTRATOR:	MYESHA MACK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 812-3674
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	14	CENSUS: 7	DATE:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Myesha Mack, Licensee		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Licensee is operating out of ratio.

INVESTIGATION FINDINGS:

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On 4/20/23 at 9:30 AM Licensing Program Analyst (LPA) Susann Sanchez conducted complaint investigation visit to deliver the findings for the above allegation. LPA knocked serval times and did hear children, Licensee assistant answered and and checked LPA badge and then asked to wait until she had confirmation from the Licensee to let LPA in. Licensee arrived around 9:45am. Licensee gave LPA a tour of the facility. LPA observe 7 children with 3 adults.

During the course of the investigation, LPA reviewed Resource and Referral time sheets. Based on the review, LPA observed the second week of February listing the following attendance between the hours of 3:00pm and 4:00pm: 13 preschool, at least 7 school age and two infants. Per Title 22 regulations (and using the Licensee’s two infants in attendance that week), the Licensee could only have two school age with 10 preschool children to be in compliance. The Licensee was out of ratio by three preschool children and at least five school age when factoring in her two infants.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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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: 04/20/2023

NARRATIVE

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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.

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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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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: 04/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/21/2023 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 interview and record review, it was discovered that on the second week of February between	1 2 3 4 5 6 7	Per Licensee since 04/04/23 visit, Licensee has talked to parents about ratio and being over capacity and has changed children's schedule around. Licensee will submit updated schedule to LPA. Licensee stated that she has been in contact with TSP for additional assistance.
	8 9 10 11 12 13 14	the hours of 3:00pm and 4:00pm: 13 preschool, at least 7 school age and two infants. 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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