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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845873
Report Date: 02/22/2023
Date Signed: 02/22/2023 03:16:52 PM

Document Has Been Signed on 02/22/2023 03:16 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MANDUJANO FAMILY CHILD CAREFACILITY NUMBER:
334845873
ADMINISTRATOR:MANDUJANO,MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 641-6640
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
02/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Maria Mandujano and Assistant Juan Mandujano TorresTIME COMPLETED:
03:40 PM
NARRATIVE
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On 2/22/2023, Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct a Case Management inspection in order to obtain information regarding the operation of the facility. LPA Lopez met with Licensee Maria Mandujano and explained the purpose of the visit. The licensee allowed entry to the facility and LPA obtained a census.

LPA Lopez was informed that the facility provides care for children that participate in a program provided by the Riverside County Office of Education (RCOE) Resource and Referral. Licensee also acts as a sub-provider for her daughter's facility (Rangel Family Child Care 33484170) when that facility is closed. Currently, Licensee Maria Mandujano, is providing temporary care for 5 children that normally attend the Rangel Family Child Care. LPA Lopez requested to review the documentation for those 5 children however, the licensee was only able to produce files for some children and not all. Also, in reviewing the facility roster, children that were currently in care were not listed.

See LIC809-D for cited deficiencies.

A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with the licensee Maria Mandujano.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/22/2023 03:16 PM - It Cannot Be Edited


Created By: Samuel Lopez On 02/22/2023 at 02:38 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MANDUJANO FAMILY CHILD CARE
FACILITY NUMBER: 334845873

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2023
Section Cited
CCR
102421(b)

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Child's Records - The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
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Licensee agrees to obtain copies of child(ren) file(s) and submit copies to the Riverside Child Care Regional Office by 2/28/2023.
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Based on record review, the licensee did not comply with the section cited above. The licensee did not have a file for review for Child #5. This poses/posed a potential health, safety or personal rights risk to persons in care.
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Please note that this is a repeat violation/citation from previous inspection on 7/19/2022. A civil penalty is being assessed in the amount of $250.00
Type B
02/28/2023
Section Cited
CCR102417(g)(8)

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Operation of a Family Child Care Home - Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
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Licensee agrees to update the facility roster and submit a copy to the Riverside Child Care Regional Office by 2/28/2023.
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Based on record review, the licensee did not comply with the section cited above. The roster that was reviewed had several names of children missing and/or information not updated as required. This poses/posed a potential health, safety or personal rights risk to persons in care.
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Please note that this is a repeat violation/citation from previous inspection on 7/19/2022. A civil penalty is being assessed in the amount of $250.00
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:Aaron Ross
LICENSING EVALUATOR NAME:Samuel Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023


LIC809 (FAS) - (06/04)
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