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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372010564
Report Date: 06/19/2023
Date Signed: 06/19/2023 01:18:13 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2023 and conducted by Evaluator Martha Malane
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20230411124611
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:14CENSUS: 0DATE:
06/19/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Chan ClarkTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Provider did not ensure safety of daycare children
Uncleared adult in the daycare
INVESTIGATION FINDINGS:
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On 6/19/23 at 12:00pm, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced inspection for the purpose of delivering findings for the above listed allegations. Upon arrival, LPA met with licensee, Chan Clark and disclosed the purpose of the inspection. There were no children present.

On 4/11/23, Community Care Licensing (CCL) received a complaint alleging the above allegations. During the course of the investigation, interviews were conducted with the licensee and daycare parents. Records were obtained from the licensee and outside agencies.

Inconsistent statements were obtained for the allegations of provider not ensuring the safety of daycare children and uncleared adult in the daycare; therefore, the allegations were determined to be unsubstantiated. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

See LIC9099C continuation...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 20-CC-20230411124611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/19/2023
NARRATIVE
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No deficiencies cited.

Exit interview conducted with licensee, Chan Clark. A notice of site visit was provided and must remain 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: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2