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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400807
Report Date: 12/05/2023
Date Signed: 12/05/2023 11:51:09 AM

Document Has Been Signed on 12/05/2023 11:51 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CLARK FAMILY CHILD CAREFACILITY NUMBER:
198400807
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Shakeena Clark TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Warren Birks conducted a Case Management inspection. LPA Birks met with Licensee Shakeena Clark who guided analyst on a tour of facility. The purpose of the today's inspection is to inspect the remodeled garage as the Licensee will be using it as a daycare space.

LPA observe the garage appear to be clean and safe and free of uncommon hazards. LPA informed Licensee that the garage can be used as an activity space at this time however, children may not eat or sleep in the garage. LPA informed Licensee she may set up tables outside as a dual option for children to eat outside during days the weather is permissible.

LPA informed Licensee that if at some point in the future; if she chooses to use the garage for eating or sleeping, She will need to make it a livable space adhering to all the government requirements of permitted livable spaces. If the space has a separate address from the license, then it may not be used for child care.

LPA informed Licensee to contact 323-981-3350 before making any decisions regarding construction and/or major changes in operations at the facility and items mentioned are subject to change depending on Title 22 and safety of children.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Shakeena Clark

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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