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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019959
Report Date: 06/21/2024
Date Signed: 06/21/2024 12:06:29 PM

Document Has Been Signed on 06/21/2024 12:06 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MACK FAMILY CHILD CAREFACILITY NUMBER:
198019959
ADMINISTRATOR/
DIRECTOR:		MYESHA MACKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 812-3674
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/21/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:MYESHA MACK / LICENSEETIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Ashley Calderon arrived at the facility at 9:35am on 6/21/24 for an unannounced continuation annual inspection. At 9:28 staff LaShawn McGinnie opened the door and closed it on LPA Calderon, LPA Calderon heard children talking from a distance. McGinnie stated to LPA will let Licensee Myesha Mack aware of LPA's arrival to the facility. LPA continued to wait outside, rung door bell again, no answer, At 9:35am Licensee Myesha Mack arrived and granted LPA entry into the facility and LPA disclosed purpose of todays visit.

LPA gave Licensee assistance and informed licensee that during hours of operation, staff present caring for children per regulations to stay in compliance should allow LPA into the facility without Licensee's presence.

During arrival LPA Calderon observed 8 children (1 infant) and 2 staff and at 9:59 am another child arrived making census 9. Per Licensee, infant is part day and does not nap at facility. During today's visit LPA Calderon requested staff and children record review to complete the annual inspection. At 9:45 LPA Calderon requested assistance via telephonically with LPA Jonnisha Culbert, to check on staff LaShawn McGinnie. LPA reviewed LIS Personnel Summary and didn't see staff associated. LPA Culbert used Guardian to confirm clearance of staff McGinnie and LPA Culbert associated staff to above facility, facility had LIC9182 completed and McGinnie's Drivers License on file. All staff present were found cleared.

At 10:22am another child arrived making census 10.

At 10:27am Licensee asked staff #2 for immunization records. LPA Calderon observed staff #2 having tuberculous record on file but missing immunization records for pertussis and measles, Staff #2 and Licensee were unable to provide completed immunization records for staff, deficiency cited. During record review: Licensee, Staff #2 and Staff #3 did not have a the correct pediatric CPR/First Aid Certificate requested by LPA, deficiency cited. (Page 1, continuation 809-C.... )
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2024 12:06 PM - It Cannot Be Edited


Created By: Ashley Calderon On 06/21/2024 at 11:40 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
, 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: 06/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation, interview with Licensee, and record review Staff #2 did not have pertussis and measles immunization records, the licensee did not comply with the section cited above in [1] out of [3] staff present which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2024
Plan of Correction
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Licensee will have staff #2 complete immunization records and sent to LPA via text by poc due date
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation during record review for Licensee, staff #2 and staff #3, did not see the correct pediatric CPR/First aid that is in compliance with Licensing Title 22 Regulations , the licensee did not comply with the section cited above in [3] out of [3] staff persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2024
Plan of Correction
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Licensee,staff #2, Staff #4 will complete CPR/First Aid and sent to LPA via text by poc due date
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
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MACK FAMILY CHILD CARE
FACILITY NUMBER: 198019959
VISIT DATE: 06/21/2024
NARRATIVE
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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 at https://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.

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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

(Page 2, Continuation 809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MACK FAMILY CHILD CARE
FACILITY NUMBER: 198019959
VISIT DATE: 06/21/2024
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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. Based on today’s visit, Per California Code of Regulations Title 22, deficiencies were cited and provided on LIC 809-D.

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

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

(Page 3, End of report.)

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
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