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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019959
Report Date: 01/16/2026
Date Signed: 01/16/2026 01:02:04 PM

Document Has Been Signed on 01/16/2026 01:02 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: DATE:
01/16/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:22 AM
MET WITH:Facility Representative Shanequa FarmerTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On 1/16/2026 at 9:28am, Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced annual/random inspection at the above facility. Facility Representative Shanequa Farmer opened the door at 9:10am and said one second. LPA heard children present. At 9:38am S.Farmer granted LPA entry into the facility. LPA Calderon had to call Licensee in order for staff to allow entrance. Facility Representative Shanequa Farmer allowed LPA entrance and LPA Calderon disclosed purpose of today's inspection.

Licensee Myesha Mack was not present. Upon entrance there was 8 children present during today's inspection (2 whom were infants) with 2 staff assistants. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 7:00 AM - 6:00PM.

Guardian roster was reviewed. Staff assistants were noted. Staff #1 is cleared and per file review is qualified to be with children when Licensee is not present. LPA reminded staff Licensee absent should not exceed 20% of hours of operation. Based on record review of Guardian Roster conducted by LPA Calderon: Staff #2 (S2) not associated under the facility, LPA Alicia Mooberry who assisted via telephonically, in the individual search on Guardian shows (S2) has fingerprinted clearance- exemption and is not associated under the above facility, therefore transfer was not completed properly, LPA Calderon reviewed the incorrect transfer form was completed LIC9182, instead of the exemption transfer LIC9188, deficiency and civil penalty was cited, individual left the facility at approx 10:50am. Licensee stated will get them transferred before returning to the facility. Staff #1 was left with 7 children. Individuals residing in the home have been discussed and noted. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 01/16/2026
NARRATIVE
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This is a two-story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room (multipurpose child care room), living room (day care room), front yard, and backyard (fenced). Staircase has a baby gate to prevent children from access to upstairs of the home.

Per licensee, areas off limits to children and parents include: 4 bedrooms upstairs and 2 restroom upstairs. The children and use: the multipurpose dining room, 1 downstairs bathroom, backyard (fenced), and day care/ living room. Garage access from the dining room kept locked and inaccessible to children in care.

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form. LPA provided (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster and LIC 610- Facility Disaster Plan. LPA Calderon at 10:55am reviewed Disaster drill log , last drill conducted on 8/12/25, drill to be conducted every 6 months. Carbon monoxide detector device was tested by S.Farmer, was tested and found operable. Fire extinguisher indicated fully charged, receipt reviewed of purchase date 10/10/2025. The home maintains telephone service via cell phone and landline line. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children inside and outside of the home.

Detergents and leaning compounds are stored in the inaccessible garage. Knives were observed inaccessible to children placed in a high to reach shelf in the kitchen cabinet. Licensee understands that all poisons must be locked, per licensee text message stated: no poisons stored in the home. Per Licensee, via text stated there are no firearms or weapons stored in the home. Per Licensee, via text stated: no children on medication. Facility provides children with food. LPA advised staff: if foods are brought from children home should be labeled and sealed and stored correctly. Staircase has baby gate in place. LPA observed central AC and ventilation system placed on throughout the home on ceiling or high to reach areas of the wall.

Children use the backyard for outdoor play. LPA observed children playing in the back yard, only half of the backyard is accessible to children. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA observed half of backyard inaccessible to children in care, fenced off with a fence which maintains storage large items and toys that are unused , and toys that are used to rotate toys for children to play with. There are no pools or spas, or other bodies of water on premises.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
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: 01/16/2026
NARRATIVE
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LPA Calderon reviewed staff files. Staff #1- missing MMR-measles vaccination, deficiency cited. Pediatric 1st aid and cpr expires - 6/2026 and Mandated reporter expires 6/19/26, staff #2 Incorrect Transfer request form and sent to the incorrect email to process transfer. Licensee Mack file was reviewed: Mandated reporter expires 1/9/27 and Pediatric 1st aid and cpr expires - 6/2026.

LPA Calderon saw a 15 Sleep log, although left blank, during visit LPA did not observe napping infants. Per Licensee Mack via telephonically stated infants leave at 12pm and no not nap at the facility. LPA Calderon informed staff #1 and Licensee Mack, play yards or cribs must be available for each infant present, or if infant can climb and crib/play yard is unsafe can use cots or mats to transition infant. During the visit LPA Calderon observed on Play yard, LPA Calderon informed staff and licensee to have a firm mattress, consultation was given, Licensee ordered mattress for play yard and sent confirmation of purchase via text message. Child #1 (C1) record was reviewed by LPA Calderon - infant file of C1 during file review did not have an LIC9227 Individual Infant Safe Sleep in file, child is under 12 months old, deficiency cited. Total LPA Calderon reviewed 4 files for 3 out of 4, these files had appropriate documentation in place

At approx. 11:47am Staff #3 arrived who is fingerprinted cleared.
  • 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.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/16/2026 01:02 PM - It Cannot Be Edited


Created By: Ashley Calderon On 01/16/2026 at 12:02 PM
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: 01/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(3)
Request and be approved for a transfer of a criminal record exemption, as specified in Section 102370.1(p), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review of Guardian Roster conducted by LPA Calderon: Staff #2(S2) not associated under the facility, LPA Alicia Mooberry who assisted in individual search on Guardian shows (S2) has fingerprinted clearance- exemption and is not associated under the above facility, therefore transfer was not completed properly, LPA Calderon reviewed the incorrect transfer form was completed LIC9182, instead of the exemption transfer LIC9188, deficiency and civil penalty was cited, individual left the facility at approx 10:50am., the licensee did not comply with the section cited above in [1] out of [1] individual with approved and associated exemption for the above facility for staff #2,which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2026
Plan of Correction
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Licensee during visit notified via telephonically Staff #2 to leave the home and via text Licensee Mack stated will contact Guardian now. Staff #3 came to assist at the facility who was fingerprinted cleared. Upon clearance of Staff #2 to return at the facility Licensee ensure with LPA Calderon individual is associated under the above facility to clear POC.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/16/2026 01:02 PM - It Cannot Be Edited


Created By: Ashley Calderon On 01/16/2026 at 12:15 PM
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: 01/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102391(a)
Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes, and in accordance with Section 102396.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation: On 1/16/2026 at 9:28am, Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced annual/random inspection at the above facility. Facility Representative Shanequa Farmer opened the door at 9:10am and said one second. LPA heard children present. At 9:38am S.Farmer granted LPA entry into the facility. LPA Calderon had to call Licensee Mack in order for staff to allow entrance. Facility Representative Shanequa Farmer allowed LPA entrance and LPA Calderon disclosed purpose of today's inspection. , the licensee did not comply with the section cited above in [1] out of [1] did not allow entrance to the facility at any time , LPA Calderon had to wait outside from 9:28am-9:38am which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2026
Plan of Correction
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Licensee will send LPA Calderon a plan to inform staff to grant Licensing Analyst from the Child Care Licensing entrance upon arrival at the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/16/2026 01:02 PM - It Cannot Be Edited


Created By: Ashley Calderon On 01/16/2026 at 12:21 PM
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: 01/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon reviewing records for staff files. Staff #1- missing MMR-measles vaccination, the licensee did not comply with the section cited above in [1] out of [4] vaccination record was not in file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2026
Plan of Correction
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Licensee will retrieve MMR Vaccination record and sent to LPA Calderon by poc due date 1/30/26.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Child #1 (C1) record was reviewed by LPA Calderon - infant file of C1 during file review did not have an LIC9227 Individual Infant Safe Sleep in file, child is under 12 months old, the licensee did not comply with the section cited above in [1] out of [1] infant who is between 0 months - 24 months did not have document lIC9227 in file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2026
Plan of Correction
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Licensee will have parent of Child #1 to complete the LIC9227 Individual Infant Sleeping Plan and send to LPA Calderon 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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2026


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: 01/16/2026
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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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
  • 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.


Based on this information the following deficiencies on the LIC 809 D per California Code of Regulation Title 22, were cited today 1/16/26. During this visit 3- Type B's were cited and 1 Type A.

LPA Ashley Calderon informed facility representative that this report dated 1/16/26 document(s) 1- Type A citation, which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.



Also, LPA Ashley Calderon informed the Facility Representative Shanequa Farme to provide a copy of this licensing report dated 1/16/26 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. A notice of site was given, must be posted along with report-narrative. An exit interview was conducted with Facility Representative Shanequa Farmer, Appeal Rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC809 (FAS) - (06/04)
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