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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001082
Report Date: 10/07/2025
Date Signed: 10/07/2025 01:29:57 PM

Document Has Been Signed on 10/07/2025 01:29 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/
DIRECTOR:		CLARK, JENNIFER L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 728-6827
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 10DATE:
10/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Jennifer ClarkTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On October 7, 2025 at approximately 10:55am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Jennifer Clark, and explained the purpose of the visit.

Present during LPA's visit included licensee, licensee's spouse/assistant and 10 enrolled children (4 infants and 6 preschool children). Licensee is a large licensee with an assistant present, and is operating within capacity limits and ratio during LPA's visit conducted on this date.

Licensee lives in the multi-level home with their spouse and minor child. Both licensee and their spouse have fingerprint clearance on file. LPA informed licensee when their minor child turns 18 years old, fingerprint clearance must be obtained.

Licensee operates their family child care home from Monday through Friday 7:30am to 6:00pm or 9:00am to 3:30pm, depending on children's schedules.

The home consists of three levels. The family child care home operates on the ground level of the home only. The DAY CARE AREAS are the entire ground level of the home (except garage) and the backyard area. The OFF-LIMIT AREAS are the garage, entire second level (pass by only for entrance) and third level of the home. There are stairs in the home that are made inaccessible with child safety gates.

LPA inspected day care areas for health and safety hazards. Day care area includes variety of toys and materials. Per licensee, toys and materials are sanitized weekly. There is furniture for children's use that are age appropriate. Home is appropriately ventilated with a comfortable temperature. Main day care area includes carpet and rugs that are clean. Per licensee, carpet and rugs are vacuumed daily. LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers. LPA also observed poisons, chemicals and cleaning solutions to be stored in a high shelf, inaccessible to children.

Home is equipped with a fully charged fire extinguisher, smoke detector, carbon monoxide detector and first aid kit. Carbon monoxide detector was tested during visit and was observed to be in working condition.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 10/07/2025
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There is a restroom on the ground level of the home that is for children's use, if needed. Per licensee, all enrolled children are currently in diapers and are not utilizing children's restroom. LPA observed children's restroom to have age appropriate toileting equipment. Per licensee, children's families provide diapers and wipes. LPA observed diapers and wipes to be stored sufficiently.

Children sleep throughout the day care areas in pack and play cribs. LPA observed cribs to be stored away, when not in use. Per licensee, preschool age children sleep in cribs with sheets and blankets. Sheets and blankets are provided by both children's families and licensee. Per licensee, sheets and blankets are laundered every other week or as needed.

Per licensee, infant children sleep in cribs that are free of loose articles and objects. Licensee maintains sleeping logs for infants. LPA reviewed random selection of sleeping logs maintained from November through December 2024, January through February 2025 and September through October 2025. Sleeping logs document the date the infant is sleeping, the 15 minute time stamp of when the napping infant is checked on and the initials of the licensee.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

Backyard is fully fenced and enclosed. Backyard includes a variety of outdoor toys and equipment. Children utilize outdoor shoes when in the backyard. There is a sandbox in the backyard that includes a cover. There are also stairs in the backyard that are made inaccessible with a child safety gate. LPA did not observe any pools, spas or bodies of water on site.

Licensee provides a food service that includes snacks and lunch. Reusable dishes and materials are utilized and sanitized on site daily. Per licensee, no enrolled children currently have any allergies. Per licensee, if a child had an allergy, medication would be stored in their designated cubby with appropriate documentation.

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/.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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: 10/07/2025
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LPA reviewed facility records that included all enrolled children's records. Children's records are complete with emergency information. Licensee has a current CPR and First Aid certification that will expire 2/2027. Licensee's Mandated Reporter certificate is also current and will expire 1/2026. Licensee's spouse also has a current Mandated Reporter certificate that was made available for LPA's review. Licensee has immunizations made available on their mobile phone. LPA advised licensee to maintain printed copy of immunizations for licensee and spouse on site. A technical violation was issued.

Licensing documents are posted and made available for review in the main entrance of the facility. A childcare roster is maintained and was made available for review during today's visit. Emergency disaster drills are conducted at least once every six months. Last documented drill was conducted June 26, 2025. There are pets in the home that are separate from children in care, located in off limit areas. Per licensee, there is no smoking in the home. 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 at
www.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.

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.

No deficiencies were issued today during LPA's visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Jennifer Clark.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC809 (FAS) - (06/04)
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