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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372010564
Report Date: 06/02/2023
Date Signed: 06/03/2023 03:28:54 PM

Document Has Been Signed on 06/03/2023 03:28 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: 6CENSUS: 1DATE:
06/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Chan ClarkTIME COMPLETED:
03:59 PM
NARRATIVE
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On 6/2/23 at 2:10pm, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced case management deficiency inspection. Upon arrival, LPA met with Licensee, Chan Clark and discussed the purpose of the inspection and was led on a tour of the facility. There was one (1) child in care.

At 2:18pm, licensee’s uncleared adult daughter, Daughter #1 (D1) entered the living room from the backyard. D1 stated she was in the backyard installing a shed. LPA reminded licensee that all adults over the age of 18 years must have a fingerprint clearance; licensee stated she understood. Licensee stated D1 was only in the backyard and licensee only had one (1) child in care, so there should not be a problem with D1 being at the home and in the backyard. Per licensee, during a previous inspection on 8/5/22, the backyard is utilized by children for outdoor play. 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.

Per California Code of Regulations, (Title 22, division 12 & Chapter 3) deficiencies cited; see LIC809D pages and civil penalties assessed. LPA, Martha Malane informed Licensee, Chan Clark that this report dated 6/2/23 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPA, Martha Malane informed the licensee to provide a copy of this licensing report dated 6/2/23 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted with Licensee, Chan Clark. A notice of site visit was provided and must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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 06/03/2023 03:28 PM - It Cannot Be Edited


Created By: Martha Malane On 06/02/2023 at 03:25 PM
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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CLARK, CHAN FAMILY CHILD CARE
FACILITY NUMBER: 372010564

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2023
Section Cited
CCR
102370(d)(1)

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102370(d)(1) 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: (1) Obtain a California clearance or a criminal record exemption as required by the Department
This requirement is not met as evidenced by:
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Licensee stated she will ensure all adults have a fingerprint clearance prior to being in the day care.
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Based on record review and licensees' statement, the licensee did not comply with the section cited above as daughter #1 did not obtain a criminal record clearance, which poses an immediate health, safety or personal rights risk to persons 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:Tulam Vu
LICENSING EVALUATOR NAME:Martha Malane
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
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