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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843745
Report Date: 08/15/2024
Date Signed: 08/15/2024 10:20:38 AM

Document Has Been Signed on 08/15/2024 10:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MANSELL FAMILY CHILD CAREFACILITY NUMBER:
334843745
ADMINISTRATOR/
DIRECTOR:		AMANI MANSELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 208-4087
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 25CENSUS: 3DATE:
08/15/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Amani MansellTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Sumayya Habeebulla and Cindy Hamilton, conducted a Plan of Correction (POC) visit on this date to ensure deficiencies cited during Annual Inspection conducted on 07/10/24. were corrected, LPA toured the facility, took census, and met with Licensee Amani Mansell, who was informed of the reason for the premise visit.

On 07/10/2024 during an annual visit the facility was cited for the following deficiencies and the corrections were not submitted by the POC due date of 07/24/24. LPA emailed the licensee on 07/26/24, 08/01/24, 08/09/24, and a voice message was placed to Licensee on 08/01/24 reminding Licensee of the pending POCs. LPA did not receive any response from the Licensee as of this date.

Deficiencies that are still pending are as follows -

1. MMR & TDAP for S1 - Based on interview made during today’s visit, the plan of correction has not been met for the pending immunization. Facility is being cited for a repeat violation.

The following were corrected during this visit -

1. CPR & First Aid for S1 & S2 - during this visit Licensee provided proof of CPR & First aid for S2 and Licensee stated that there is a delay in receiving the card for S1 and licensee is in contact with the vendor to obtain the completion card for S1.

2. Preventive Health & Safety Training for S1 - Licensee provided a written statement during this visit explaining that they are in the process of obtaining the health & safety certification for S1 and S1 will not be left alone to supervise the children until the certification is obtained.

See LIC 809D for deficiencies cited.

An exit interview was conducted, and a copy of this report was provided to Licensee. A Notice of Site Visit was issued and the Licensee understands that it must remain posted for 30 days.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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 08/15/2024 10:20 AM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 08/15/2024 at 09:53 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MANSELL FAMILY CHILD CARE
FACILITY NUMBER: 334843745

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2024
Section Cited
HSC
1597.622(a)(1)

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(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 ....an influenza vaccination... of each year.
This requirement is not met as evidenced by:
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Licensee stated they will be submitting proof of immunization - MMR, TDAP, and flu vaccine for S1 to the department by the new POC due date.
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Based on record review, the licensee did not comply with the section cited above in having a record for MMR, TDAP, and flu vaccine records which poses a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


LIC809 (FAS) - (06/04)
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