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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845873
Report Date: 06/15/2023
Date Signed: 06/15/2023 03:10:18 PM

Document Has Been Signed on 06/15/2023 03:10 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: 9DATE:
06/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Maria MandujanoTIME COMPLETED:
03:25 PM
NARRATIVE
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On 6/15/2023, Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct an annual inspection. At the conclusion of the inspection, LPA Lopez observed that the Licensee Maria Mandujano was left alone with 9 children in care. LPA Lopez inquired about her assistant (Juan Mandujano) and she disclosed that her had left to pick up food. LPA Lopez informed and explained to the Licensee that without an assistant, the Large license reverts back to the guidelines of a Small license, therefore she was over limitations/capacity of her license. Also, LPA Lopez observed more than one child drinking from the same bottle.

See LIC809-D for cited deficiencies.

LPA Samuel Lopez informed licensee Maria Mandujano that this report dated June 15, 2023 document(s) (2) Type A citation(s) 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.

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.


Also, LPA Samuel Lopez informed the licensee Maria Mandujano to provide a copy of this licensing report dated June 15, 2023 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.

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: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2023
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 06/15/2023 03:10 PM - It Cannot Be Edited


Created By: Samuel Lopez On 06/15/2023 at 02:20 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: 06/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2023
Section Cited
CCR
102416.5(e)

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Staffing Ratio and Capacity: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
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Licensee is to submit a written statement/plan as to how she will be in compliance with the cited regulation section. Statement/Plan to be submitted to the Riverside Child Care Regional Office by 6/16/2023.
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Based on observation, the licensee was left alone with 9 children while her assistant left the facility to pick up food. This poses an immediate health, safety or personal rights risk to persons in care.
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Type A
06/16/2023
Section Cited
CCR102423(a)(2)

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Personal Rights: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by: Based on the observation made of a child drinking from a bottle that another had just drank from previously.
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The Licensee immediately removed the bottle from the child's mouth. Licensee agrees to submit a written statement/plan as to how she will be in compliance with the cited regulation section. Statement/Plan to be submitted to the Riverside Child Care Regional Office by 6/16/2023.
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This is neither safe or healthful and therefore poses an immediate 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:Aaron Ross
LICENSING EVALUATOR NAME:Samuel Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023


LIC809 (FAS) - (06/04)
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