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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334830033
Report Date: 11/01/2023
Date Signed: 11/01/2023 12:09:04 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/25/2023 and conducted by Evaluator Jessica M Rubio
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20231025143006
FACILITY NAME:MAXWELL FAMILY CHILD CAREFACILITY NUMBER:
334830033
ADMINISTRATOR:MAXWELL, MARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 550-7083
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:14CENSUS: 10DATE:
11/01/2023
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Mary MaxwellTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Licensee does not ensure children’s immunizations are current.
INVESTIGATION FINDINGS:
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On November 1, 2023 at 11:03 am, Licensing Program Analyst (LPA) Jessica Rubio arrived unannounced to Maxwell Family Child Care Home, (FCCH) to initiate the complaint investigation regarding the allegation listed above. LPA met with Licensee Mary Maxwell and conducted a census of the facility. LPA also interviewed licensee and reviewed records for one child (C1).

On October 25, 2023, a complaint was received alleging licensee does not ensure children’s immunizations are current; specifically, that C1 attended the FCCH without having the required immunizations. Interview and record reviewed revealed that C1 attended the facility from April 2021 through July 2023. Record review revealed C1 did not have the required immunizations when C1 was enrolled and attending the FCCH and licensee did not receive any immunization updates throughout enrollment.

Continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
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 3
Control Number 10-CC-20231025143006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MAXWELL FAMILY CHILD CARE
FACILITY NUMBER: 334830033
VISIT DATE: 11/01/2023
NARRATIVE
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Based on the interview and record review, the preponderance of evidence standard has been met and the allegation that licensee does not ensure children’s immunizations are current is substantiated. The facility is being cited for Title 22 Regulations Section 102418 (c). See LIC 9099-D for cited deficiencies.

An exit interview was conducted, this report was reviewed with and provided to Licensee Mary Maxwell. Appeal rights were also discussed and given to the licensee. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20231025143006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MAXWELL FAMILY CHILD CARE
FACILITY NUMBER: 334830033
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2023
Section Cited
CCR
102418
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Immunizations (c) California Code of Regulations, Title 17, Section 6020, as summarized, requires that children receive vaccines as follows: 15 - 17 months 3 each of Polio and DTP, 2 Hep B, I MMR; must be on or after the first birthday At least 1 Hib given on or after the first birthday (regardless of any doses given before the first birthday). This requirementnwas not met as evidenced by:
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C1 is no longer enrolled and licensee showed LPA the Imm-408 window chart that she now uses to verify immunizations are current.
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Based on record review C1 did not have the required immunizations which poses a potential health, safety or personal rights risk to children 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.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3