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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820103
Report Date: 02/08/2022
Date Signed: 02/08/2022 10:53:38 AM

Document Has Been Signed on 02/08/2022 10:53 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MADAIN FAMILY CHILD CAREFACILITY NUMBER:
334820103
ADMINISTRATOR:MADAIN, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 864-7111
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/08/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Norma MadainTIME COMPLETED:
11:00 AM
NARRATIVE
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On 2/8/2022, Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to address a separate issue. LPA Lopez spoke with the Licensee Norma Madain regarding her child care. She stated that she had not provided any care for a month to two months however, later disclosed caring for one child in the last two weeks. Also, LPA Lopez named all adults listed in the facility roster and Norma verified which ones were still associated. Norma then disclosed that her son Rico Ortiz (age 20) was living at her home but, did not have a Criminal Record Clearance. She also mentioned, Chelsea Jelks, as another adult that was recently living at the facility and just finding out that she did not have a clearance either. According to Norma, she allowed Chelsea to live with her until the end of January 2022.

LPA Lopez requested facility documentation, such as a children's roster and files. The licensee was only able to produce one file of a child previously in care. She stated to have misplaced the roster.

During the visit, the licensee requested to forfeit her license. A statement requesting the forfeiture, along with the license was given to the LPA.

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.

This facility was found to be out of compliance with Title 22 regulations.

See LIC809-D for cited deficiencies.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MADAIN FAMILY CHILD CARE
FACILITY NUMBER: 334820103
VISIT DATE: 02/08/2022
NARRATIVE
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Exit interview conducted and report was reviewed with the licensee Norma Madain.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/08/2022 10:53 AM - It Cannot Be Edited


Created By: Samuel Lopez On 02/08/2022 at 10:23 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MADAIN FAMILY CHILD CARE
FACILITY NUMBER: 334820103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2022
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance: 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: Obtain a California clearance or a criminal record exemption as required by
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Licensee had surrendered her facility/child care license.
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the Department. This requirement was being met as evidenced by the licensee allowing her adult son and another adult (Chelsea Jelks) to live at the home without a criminal record clearance. This poses an immediate risk to the children in care.
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A civil penalty of $1000.00 will also be added to this citation

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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: 02/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/08/2022 10:53 AM - It Cannot Be Edited


Created By: Samuel Lopez On 02/08/2022 at 10:34 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MADAIN FAMILY CHILD CARE
FACILITY NUMBER: 334820103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2022
Section Cited
CCR
102417(g)(8)

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Operation of a Family Child Care: Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not being met as evidenced by the licensee not being able to produce roster for the children she has/had provided care for.
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Licensee agrees to submit a roster to the Riverside Child Care Regional Office by 2/18/2022.
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This poses a potential risk to the 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.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Samuel Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2022


LIC809 (FAS) - (06/04)
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