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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372010564
Report Date: 10/25/2021
Date Signed: 08/07/2022 12:19:15 PM

Document Has Been Signed on 08/07/2022 12:19 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CLARK, CHAN FAMILY CHILD CAREFACILITY NUMBER:
372010564
ADMINISTRATOR:CLARK, CHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 225-1490
CITY:SAN DIEGOSTATE: CAZIP CODE:
92107
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 5DATE:
10/25/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Chan ClarkTIME COMPLETED:
12:10 PM
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On 10/25/2021 at 10:00am, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced Plan of Correction (POC) inspection at the facility. Purpose of this inspection is to ensure citations issued during an annual inspection dated 10/15/2021 were corrected. Upon arrival, LPA met with Licensee, Chan Clark and proceeded to tour the facility.

There were five (5) children, including one (1) infant and one (1) school age child during today’s inspection.

The following citations issued on 10/15/21 were corrected as follows:

Immunization records for Child #1 and Child #2 were found to be complete.

Infants enrolled in the day care shall have an up to date LIC9227.

A log to document checks every 15 minutes for each sleeping infant was reviewed with licensee.

Licensee is able to hear and observe sleeping infants and the door is to remain open to the room where an infant is sleeping.

Licensee stated her daughter, Erika Laraya will no longer work in the day care, therefore immunization records, CPR/First Aid and Mandated Reporter certificate review was not required at this time.

LPA reviewed staff files and they were found to be complete with required documents. Licensee's current CPR/First Aid certificate was on file and expires 10/24/2023.

LPA observed the fireplace to be screened and inaccessible to children.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2021
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CLARK, CHAN FAMILY CHILD CARE
FACILITY NUMBER: 372010564
VISIT DATE: 10/25/2021
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Licensee removed all items from cribs and play yards for napping infants and stated she will comply with all safe sleep regulations.

No deficiencies sited during today’s inspection.

An exit interview was conducted with Licensee, Chan Clark and a copy of this report, appeal rights (LIC 9058 1/16) and Notice of Site Visit – LIC 9213 were provided to licensee.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021
LIC809 (FAS) - (06/04)
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