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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426216267
Report Date: 09/08/2025
Date Signed: 09/08/2025 04:13:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2025 and conducted by Evaluator Gigi Reyes
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20250904152024
FACILITY NAME:CLARK FAMILY CHILD CAREFACILITY NUMBER:
426216267
ADMINISTRATOR:JANA HELENE CLARKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 714-9381
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 8DATE:
09/08/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jana Helene ClarkTIME COMPLETED:
02:29 PM
ALLEGATION(S):
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Infant children do not have an individual sleeping plan.
INVESTIGATION FINDINGS:
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 On 09/08/2025 at 10:45 AM PST, Licensing Program Analysts (LPAs) Seena Parsapour and Gigi Reyes made an unannounced inspection of the aforementioned Family Child Care Home (FCCH) in order to initiate an investigation of the above allegation. LPAs met with Jana Helene Clark, Licensee of the FCCH, and explained the nature of the inspection. LPAs note eight (8) children are on site at the time of the inspection.
The investigation included record review, observation and interviews of the Complainant and Licensee. LPAs note children in care were not interviewed. LPAs interviewed licensee Jana Helene Clark, as well as assistant Maria De Los Angeles Garcia.
The allegation of the complaint states that the Licensee failed to maintain a current individual infant sleeping plan, LIC9227, on file. (CONT. 9099-C, Page 2)



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
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 5
Control Number 17-CC-20250904152024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CLARK FAMILY CHILD CARE
FACILITY NUMBER: 426216267
VISIT DATE: 09/08/2025
NARRATIVE
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 The investigation revealed corroborating information regarding the allegation. Namely, after record review & interviewing the licensee, the licensee admitted that she did not provide an LIC9227 to the parent of C1.

LPAs note that this is an isolated case, as record reviews revealed individual infant sleep plan form LIC9227 on file for other infant children in care below one (1) year of age; namely, children's files for C2 and C3 were found to be complete, containing this form.

Based on LPAs’ observation and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation, (Title 22 Division 12 and 102425(c), is being cited on the attached LIC 9099 D).

Licensee was provided and advised of their Right to Appeal (LIC 9058). The Notice of Site Visit (LIC 9213) was provided to the Licensee as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 17-CC-20250904152024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CLARK FAMILY CHILD CARE
FACILITY NUMBER: 426216267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2025
Section Cited
CCR
102425(c)
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102425(c) Infant Safe Sleep
(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.
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Licensee will submit a written plan to CCLD (gigi.reyes@dss.ca.gov) by 09/18/25, detailing how Licensee plans on ensuring that an LIC9227 is completed and maintained on file for all infants under care one (1) year of age and below in care,
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Based on observation, the licensee did not comply with the section cited in that the LIC9227 was not provided to the parent of C1 or kept on file at the home, which poses a potential health, safety or personal rights risk to persons in care.
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and children's files are maintained at the home for a minimum of three (3) years after the child's departure.
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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: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2025 and conducted by Evaluator Gigi Reyes
COMPLAINT CONTROL NUMBER: 17-CC-20250904152024

FACILITY NAME:CLARK FAMILY CHILD CAREFACILITY NUMBER:
426216267
ADMINISTRATOR:JANA HELENE CLARKFACILITY TYPE:
810
ADDRESS:4697 STILLWELL ROADTELEPHONE:
(805) 714-9381
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 8DATE:
09/08/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jana Helene ClarkTIME COMPLETED:
02:29 PM
ALLEGATION(S):
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Children are left unattended in a closed room during nap time.
Licensee keeps children awake until scheduled nap time.
INVESTIGATION FINDINGS:
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 On 09/08/2025 at 10:45AM PST, Licensing Program Analysts (LPAs) Seena Parsapour and Gigi Reyes made an unannounced inspection of the aforementioned Family Child Care Home (FCCH) in order to initiate an investigation of the above allegations. LPAs met with Jana Helene Clark, Licensee of the FCCH, and explained the nature of the inspection. LPAs note eight (8) children are on site at the time of the inspection.
The investigation included record review, observation and interviews of the Complainant, Licensee, assistant, and parents of children in care. LPAs note children in care were not interviewed. LPAs interviewed licensee Jana Helene Clark, as well as assistant Maria De Los Angeles Garcia.
The allegation of the complaint states that children are left unattended in a closed room during nap time, and that the licensee keeps children awake until scheduled nap time.The investigation did not reveal corroborating information regarding the allegations.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTATIATED. (CONT. 9099-C).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 17-CC-20250904152024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CLARK FAMILY CHILD CARE
FACILITY NUMBER: 426216267
VISIT DATE: 09/08/2025
NARRATIVE
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 As part of the investigation, LPAs conducted parent interviews, which did not corroborate the allegations. The investigation revealed that the door to the bedroom used for infant sleeping remains open while infants are napping in the room, and that 15 minute sleep checks are being conducted while infants are asleep.

A Notice of Site Visit (LIC 9213) and Appeal Rights (LIC 9058) were provided to the Licensee, Jana Helene Clark.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Jana Helene Clark in English.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5