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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070209044
Report Date: 09/30/2025
Date Signed: 09/30/2025 02:40:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2025 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 02-CC-20250930134729
FACILITY NAME:CLARK, GUADALUPEFACILITY NUMBER:
070209044
ADMINISTRATOR:CLARK, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 937-6152
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:12CENSUS: 2DATE:
09/30/2025
UNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Teresa Ramirez/Patrick ClarkTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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One (1) allegation: Unlicensed care being provided.
INVESTIGATION FINDINGS:
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On 09/30/2025 at 2:04PM, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced complaint site inspection at the home of licensee, Guadalupe Clark. Due to LPA arriving for an inspection and found that the licensee had passed away 3/15/2025 and care for children continued, with the fingerpirnt cleared assistant, Teresa Ramirez. Patrick Clark (son of licensee) arrived shortly after, LPA provided the LIC279 (application).

Based on the information obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety Code 1596.80 is being cited on the attached LIC 9099D.

Report was reviewed, exit interview was conducted, and Appeal Rights were provided to Patrick Clark. Notice of Site Visit was given and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
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 02-CC-20250930134729
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CLARK, GUADALUPE
FACILITY NUMBER: 070209044
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/01/2025
Section Cited
HSC
1596.80
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HSC 1596.80 Child day care facilities, licenses: No person … shall operate, establish, manage, conduct, or maintain a child day care facility in this state without a current valid license...
This requirement is not met as evidenced by:
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On or before 10/01/2025, applicant must cease operation of her childcare or apply for a family child care license by providing a complete application by 10/15/2025. LPA provided provider with a copy of the LIC 279 Application for a Family Child Care Home License...
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Based on observation and interviews, it was found that applicant/provider was operating an unlicensed child care facility, which poses an immediate health, safety, and/or personal rights risk to persons in care.
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...and LIC279A License Application and Instructions for FCCH. Provider was notified that if she does not apply for an FCCH, LPA may return to the home to ensure operation has ceased. Provider was also notified a Notice of Violation may be issued.
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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.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2