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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372010564
Report Date: 08/05/2022
Date Signed: 08/07/2022 12:16:13 PM

Document Has Been Signed on 08/07/2022 12:16 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: 8CENSUS: 5DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Chan ClarkTIME COMPLETED:
02:00 PM
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On 8/5/22 at 12:pm, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced annual inspection and met with Licensee, Chan Clark. LPA disclosed the purpose of the inspection and was led on a tour of the facility. There were six (6) children in care. This facility is a single story, four (4) bedroom, two (2) bathroom house. The following areas are used for childcare: Bedroom #1, #2 and #3, bathroom #1, living room, den, family room, backyard and kitchen. The following off-limit areas are made securely inaccessible: Bedroom #4 and garage. Hours of operation are Monday – Sunday 5:00am to 7:30pm.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. LPA observed hazardous items inaccessible to children in care. LPA informed licensee poisons shall be placed in a storage area and locked. LPA observed toys and materials available for the children. The fireplace is made inaccessible through a glass door. The home has a fenced backyard available for outdoor activities. LPA informed licensee children shall be supervised while outdoors. Licensee stated there are no bodies of water and LPA did not observe any bodies of water. Licensee stated there are no weapons in the home.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee’s first aid and CPR certifications expire 4/21/23. Licensee is exempt from mandated reporter training at this time. The last fire/disaster drills were conducted and documented 4/21/22.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. See LIC809C continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CLARK, CHAN FAMILY CHILD CARE
FACILITY NUMBER: 372010564
VISIT DATE: 08/05/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. Technical Assistance provided, see LIC9102AN.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided Licensee with the following: child care advocates email address: [email protected]. LPA informed licensee in order to sign up for Quarterly Updates and PINs through our website. Please go to www.cdss.ca.gov and on the right side of your screen click on “Receive Important Updates”, put your email address in and choose which program(s) you would like to subscribe to and click “subscribe. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. LPA and licensee discussed lead prevention and LPA provided Exposure to Lead flyer.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited.

Exit interview conducted and report was reviewed with Licensee, Chan Clark.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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