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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012858
Report Date: 08/30/2019
Date Signed: 08/30/2019 03:49:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CLARK FAMILY CHILD CAREFACILITY NUMBER:
198012858
ADMINISTRATOR:CLARK, JAUNITTIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 502-0344
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY:14CENSUS: 1DATE:
08/30/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Juanita ClarkTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPAs) Susann Sanchez and Dayna Chambers, conducted an unannounced Case Management Inspection. LPAs met with Licensee Juanita Clark.The purpose for today's inspection is to ensure that the licensee is operating in full compliance and following the Stipulation Waiver and Order signed and dated December 07, 2016. LPAs also observed probationary license on the wall in the living . Probationary license status is effective 12/07/16 - 12/07/19.
Per Stipulation and Waiver and Order - CASE No. 6215113101, OAH No. 2015111002, the following was reviewed and observed:
  • Licensee shall operate in strict compliance - No deficiencies issued
  • Probationary terms is for three years and shall include unannounced inspections.
  • Stipulation shall be posted - Stipulation Waiver and Order observed to be posted.
  • Licensee shall ensure all individuals working, residing or volunteering have obtained criminal record clearance.
  • For the duration of the probationary period, Licensee shall inform all current and prospective parents of children in the facility of the facility's probationary license by providing parents a copy of this Stipulation and attached Accusation.
  • The capacity of the facility shall remain at 10 children.
  • During the probationary period, the facility shall not provide serviced to any child who is under three years of age, expect, respondent may provide care for (1) one child that is a family member, only occasionally and not on a daily basis.
  • Licensee shall take (8) eight hours per year of classes on sexual abuse and identifying potential sexual abuse and shall take (8) hours per year of classes on pediatric health and safety.
  • Ricky Ingram shall not have presence in, employment at, or have any contact with the clients of the facility.
  • Licensee shall cooperate with Department, including attending any requested office meetings and any non- compliance meetings.
An exit interview was conducted with Licensee, Juanittia Clark on this date.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019
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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