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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300586
Report Date: 10/25/2023
Date Signed: 10/25/2023 03:33:13 PM

Document Has Been Signed on 10/25/2023 03:33 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MCKENZIE FAMILY CHILD CAREFACILITY NUMBER:
336300586
ADMINISTRATOR:MCKENZIE, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 323-7121
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Kimberly MckenzieTIME COMPLETED:
03:45 PM
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Licensing Program Analyst’s (LPAs) Anastasia Flores and Amber Shaw, arrived at the facility to discuss and provide a notification letter of Order to Licensee of Immediate Exclusion from Facility for Resident, Walter Harrison V. The letter states in part, that as the result of an investigation by the California Department of Social Services (CDSS) a violation of personal rights has been cited against Walter Harrison V. CDSS has determined that the continued or future contact with clients or presence of this person in the child day care facility, constitutes a threat to the health, morals, welfare, or safety of the clients in care.

The letter states that the Department orders you to remove Walter Harrison V from any contact with clients and not allow this individual to be physically present in the facility. If you fail or refuse to comply with this order, your license to operate a child care home may be suspended or revoked under Health and Safety Code Section (1550; CCF), or (1596.885; CDC). An appeal can be made against this decision in writing to Department of Social Services - Community Care Licensing - Attention: Child Care Administrator - 744 P Street, MS T-9-14-48 Sacramento, CA 95814. The appeal must be received within 15 days of the date of this letter. The letter is dated October 24, 2023.
Licensee, Kimberly McKenzie, stated that Walter Harrison V, no longer resides in the facility as of 10/20/23. LPA confirmed that Walter Harrison V was not present during this inspection. On this date, licensee stated that they understand the Order to Licensee/Facility of Immediate Exclusion from Facility for Walter Harrison V. In addition, licensee was informed that a copy of the Immediate Exclusion letter is to be given to the parents of children enrolled and any new children enrolled, along with a signed copy of the Family Child Care Home Addendum to Notification of Parents Rights (regarding removal/exclusion – LIC 995B) and it is to be in each of the children’s files. Failure to do so will result in an immediate Civil Penalty of $100.00 per family. During the inspection this date, LPA Flores also interviewed one child in care, (see Confidential Names List, LIC 811, for children’s names).

An exit interview was conducted, and a copy of this report was provided to licensee. A copy of this report must be made available to the public for three years.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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