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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001082
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:04:25 PM


Document Has Been Signed on 02/01/2024 03:04 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CLARK, JENNIFER L.FACILITY NUMBER:
384001082
ADMINISTRATOR:CLARK, JENNIFER L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 728-6827
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:14CENSUS: 11DATE:
02/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Jennifer ClarkTIME COMPLETED:
03:45 PM
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On February 1st, 2024, at approximately 12:30 P.M., Licensing Program Analysts (LPAs) Catrina Quimbo and Janet Gil conducted an unannounced, annual inspection. LPAs met with licensee, Jennifer Clark, and explained the purpose of the inspection. Present during LPAs' visit included 11 children (5 infants and 6 preschool), licensee’s spouse and licensee’s assistant (A1) Licensee is a large license and is not operating within capacity limits and ratio.

Licensee lives in the multi-level home with husband and their one minor child. All adults living in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 7:30am to 6:00pm.

The home consists of two levels. Day care areas of the home are on the first lower level of the home only.

DAY CARE AREAS: entire first level of the home and the backyard area.

OFF-LIMITS AREAS: are the garage, entire second and third level of the home.

LPAs toured day care areas of home with licensee. LPAs observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPAs did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPAs observed electrical outlets to be made inaccessible with furniture barricading each plug. Home is equipped with a fully charged fire extinguisher and multiple dual smoke/carbon monoxide detectors. LPAs did not test detector in lower level due to children napping. LPAs did not observe any hazardous materials in accessible drawers.

LPAs observed licensee utilizes “Pack n Play” Playpen and cribs for napping children. LPAs observed playpens and cribs blocking the entrance and exit way of the lower level where the daycare is operating. LPAs informed licensee that this is a hazard and all entries and exits must be clear in case of an emergency. LPAs also observed children napping in playpens and cribs to include loose blankets. LPAs reminded licensee that napping infants sleeping in cribs or playpens should be free of any loose articles and objects, including blankets. Licensee was cited a Type B violation for loose articles in a crib.

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CLARK, JENNIFER L.
FACILITY NUMBER: 384001082
VISIT DATE: 02/01/2024
NARRATIVE
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Entire backyard is fully enclosed and fenced. Outdoor area is equipped with a variety of toys and materials. LPAs did not observe pools, spas or bodies of water.

LPAs reviewed six random children’s records which were complete. Children’s files have a record of emergency identification information and required immunizations. LPAs reviewed staff records including licensee, licensee’s spouse and A1. A1 was present during visit and was to not have fingerprint clearance. Licensee was cited a Type A violation for un-fingerprinted adult.

Licensee's CPR/FIrst Aid is current and will expire 02/16/2024. Licensee's Mandated Reporter training certification is also current and will expire 01/2026. A1 and Spouse present have required immunizations available for review.

Licensee has licensing documentation properly posted and available for review. Licensee also maintains a child care roster that was made available for review. Emergency disaster drills are conducted at least once every six months. Last disaster drill was conducted January 16th 2024. Per licensee, there are no weapons or firearms in the home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CLARK, JENNIFER L.
FACILITY NUMBER: 384001082
VISIT DATE: 02/01/2024
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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-andresources/safe-sleep as an additional resource. 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.

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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Jennifer Clark, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today’s visit, licensee was issued two Type A deficiencies for operating over capacity and an un-fingerprinted adult working in the home. Licensee was also issued one Type B deficiency for having loose materials in a crib.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were also provided during visit.

Exit interview conducted and report was reviewed with the licensee, Jennifer Clark.

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/01/2024 03:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: CLARK, JENNIFER L.
FACILITY NUMBER: 384001082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview andrecord review, the licensee did not comply with the section cited above. A1 was present working with children and did not have fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/02/2024
Plan of Correction
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LPAs reminded licensee all adults living and/or working in the home must have fingerprint clearance prior to initial presence. A1 to complete livescan and receive clearance prior to working in home.
Type A
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. 5 infants (under 24 months) were present during visit, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/02/2024
Plan of Correction
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LPAs reminded licensee of capacity limits and ratio. Licensee stated they will stagger children's schedules to comply with ratio.
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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 02/01/2024 03:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: CLARK, JENNIFER L.
FACILITY NUMBER: 384001082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPAs observed children sleeping in cribs with loose blankets which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/02/2024
Plan of Correction
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LPAs reminded licensee cribs must be free of all loose articles and objects. Licensee to remove blankets for napping infants in cribs.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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