<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070209044
Report Date: 05/20/2024
Date Signed: 05/20/2024 10:48:24 AM

Document Has Been Signed on 05/20/2024 10:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CLARK, GUADALUPEFACILITY NUMBER:
070209044
ADMINISTRATOR/
DIRECTOR:		CLARK, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 937-6152
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY: 12TOTAL ENROLLED CHILDREN: 2CENSUS: 1DATE:
05/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Teresa RamirezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/20/24 Licensing Program Analyst (LPA) Monica Mathur conducted an Unannounced Annual Inspection at Guadalupe Clark's Family Child Care Home. LPA met with Assistant, Teresa Ramirez who informed that Licensee, Guadalupe is out of town for few days and not present at home today. She stated home is open for daycare in Licensee's absence. LPA explained the purpose of today’s inspection. There were no children present at time of inspection. Teresa stated at present there are 2 children enrolled who attend couple of times a week. Children are expected to attend today. At 10:00am a child arrived.

INDOOR space was inspected. It is a single floor home. Teresa stated the following areas are in use at present. IN USE AREAS: Family room, Kitchen, Guest Bedroom, Small Bathroom in Laundry Room, Laundry area OFF LIMITS: Living room, Dining area, Bathroom in Hallway, Master Bedroom, Garage converted into Shop, Third Bedroom near Laundry Room
LPA observed some rooms that were noted on-limit areas during last inspection on 4/27/22 are now off limits to children. Teresa stated they do not use the Living room, Dining area, 3rd bedroom near laundry area, Master bedroom, Hallway bathroom. LPA informed that when these areas need to be placed back in-use, Licensee must contact CCLD and an inspection will be conducted before the rooms can to used by children again.
LPA observed sufficient materials, toys, and play equipment. All detergents, cleaning compounds, medications, and other similar items were inaccessible to children. Furniture and equipment were age appropriate and in good condition. There were no baby walkers, jumpers or bouncers observed during inspection. The home is sanitary, orderly and safe. There is a screened fireplace in the off limit living room and no stairs in the home. LPA observed a fully charged fire extinguisher that meets State Fire Marshal standards and working smoke/carbon monoxide detectors. There are no pets in the home. Last fire/disaster drill was conducted in April 2024. All required postings were observed posted on a wall.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CLARK, GUADALUPE
FACILITY NUMBER: 070209044
VISIT DATE: 05/20/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
page 2

OUTDOOR space was inspected. Play equipment was observed in safe condition and free of hazards. Heavy structure was secured to the ground. The yard was fenced and there were no bodies of water observed.
IN USE AREAS: Left side deck area, Backyard area outside the sliding door
OFF LIMIT AREAS: Upper hill area of the yard (by supervision)
Air conditioning unit near the swings needs to be cordoned off and made inaccessible to children.

FILE REVIEW: Children and Assistant files were reviewed. Child files did not contain immunization records. Licensee’s Mandated Reporter Training is current (expires 8/2024) and CPR/First Aid is current (expires in May 2024). Teresa was reminded to renew her Pediatric CPR soon as she is alone supervising children during Licensee's absences. She also needs to take the 8 hour Preventative Health & Safety training.

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

On this date, 5/20/24, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CLARK, GUADALUPE
FACILITY NUMBER: 070209044
VISIT DATE: 05/20/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
page 2

LPA discussed the Safe Sleep regulations with Assistant and 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/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

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 at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

In the areas that were evaluated, no regulatory violations were observed. Technical Violations/Advisory Notes were issued. Exit interview conducted and report was reviewed with Assistant, Teresa Ramirez. A Notice of Site Visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6