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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300663
Report Date: 01/20/2023
Date Signed: 01/20/2023 09:45:24 AM

Document Has Been Signed on 01/20/2023 09:45 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:MACEDO FAMILY CHILD CAREFACILITY NUMBER:
336300663
ADMINISTRATOR:MACEDO,ERICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 970-4485
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY: 14TOTAL ENROLLED CHILDREN: 24CENSUS: 3DATE:
01/20/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Erica MacedoTIME COMPLETED:
09:55 AM
NARRATIVE
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On January 20, 2023, Licensing Program Analyst (LPA) Alaina Wilburn conducted an unannounced case management visit. The Community Care Licensing office received information through a separate complaint that on January 11, 2023, the Licensee's mother was present with the Assistant, and she was preparing lunch for the children. At the time the complaint was generated, it was observed that the mother of Licensee was not associated to the current facility license number.

The facility is being cited in accordance with Title 22 Family Child Care Homes Regulations, Division 12, Chapter 1, Section 102370 (d)(2): Criminal Record Clearance. This posed an immediate risk to the health, safety, or personal rights to the children in care. See LIC809D for cited deficiency.

Exit interview conducted. A copy of this report, Civil Penalty Assessment (LIC 421BG), and appeal rights were discussed and provided to the licensee Erica Macedo on this date.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS ALONG WITH A COPY OF THE TYPE A DEFICIENCY (809D) CITED DURING THIS INSPECTION. A COPY OF THE TYPE A DEFICIENCY CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Alaina Wilburn
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023
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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Document Has Been Signed on 01/20/2023 09:45 AM - It Cannot Be Edited


Created By: Alaina Wilburn On 01/20/2023 at 09:00 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: MACEDO FAMILY CHILD CARE
FACILITY NUMBER: 336300663

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/21/2023
Section Cited
CCR
102370(d)(2)

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Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance
The requirement is not met as evidenced by
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Staff #1 (S1) does a have a fingerprint clearance, as she is licensed as a family child care home Provider as well. Licensee advised she does not have access to Guardian, so LPA advised her to submit an LIC 9182, along with a clear copy of her ID card to
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On January 11, 2023, the Licensee's mother was working with the Assistant and preparing lunch for the children without being associated to the facility prior to her initial presence in the facility, which poses an immediate health, safety or personal rights risk to children in care.
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Associations_Disassociations858@dss.ca.gov.

**Civil Penalties Assessed today**

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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:Stephanie Hudak
LICENSING EVALUATOR NAME:Alaina Wilburn
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023


LIC809 (FAS) - (06/04)
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