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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001082
Report Date: 02/12/2024
Date Signed: 02/12/2024 02:43:59 PM


Document Has Been Signed on 02/12/2024 02:43 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: 10DATE:
02/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jennifer ClarkTIME COMPLETED:
03:30 PM
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On February 12, 2024 at approximately 2:30pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, plan of correction (POC) visit. LPA met with licensee, Jennifer Clark, and explained the purpose of the visit. Present during today's visit included licensee's spouse.

On February 1, 2024 at approximately 12:40pm, LPAs Quimbo and Gil conducted an unannounced, annual inspection. During annual inspection, licensee was issued two Type A citations for operating over licensed capacity limits, operating with 5 infants (under 24 months), and an un-fingerprinted adult working in the home. Licensee was also issued one Type B citation for having loose materials in cribs infants were sleeping in. A POC was discussed with licensee.

As of this date, LPA observed licensee to be operating with 10 children (4 infants and 6 preschool age). During visit, LPA also observed cribs infants to be napping in to be free of loose articles or materials. Un-fingerprinted adult has also completed live scan process and has obtained fingerprint clearance. During visit, LPA also observed Notice of Site Visit to be properly posted and available for review.

LPA confirmed licensee to be operating within licensed capacity limits on this date.

Deficiencies cited on February 1, 2024 have been cleared during today's visit. LPA provided licensee with POC letters. No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Jennifer Clark.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2024
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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