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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216267
Report Date: 09/29/2023
Date Signed: 10/01/2023 09:41:26 AM

Document Has Been Signed on 10/01/2023 09:41 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CLARK FAMILY CHILD CAREFACILITY NUMBER:
426216267
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jana Helene Clark TIME COMPLETED:
03:10 PM
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On 9/29/2023, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Case Management inspection of the above Family Child Care Home (FCCH) for a change of capacity. LPA met with Jana Helene Clark, Licensee of the FCCH and explained the nature/purpose of the inspection. LPA notes that there were six (6) children present during this inspection.

During this inspection, LPA and Licensee together toured the and interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins. LPA observed cleaning compounds located in elevated cabinets in the kitchen, laundry room and garage. Sharps are in elevated cabinet in kitchen and locked drawer. Medication was observed in elevated cabinets in the kitchen. LPA notes all areas are inaccessible to children. .

LPA reviewed the Licensee’s First Aid/ CPR certification which was completed on 3/20/24. LPA observed a regulation fire extinguisher which was serviced on 4/10/23. LPA reviewed the Licensee’s Mandated Reporter Training certificate, which was completed on 3/28/22. LPA did not test combination smoke and carbon monoxide detector due to children sleeping but detector was tested during fire inspection on 9/26/23.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 9/26/2023.

The home meets Title 22 of CCR requirements for a Large Family Child Care license effective today. Effective date of license is today 9/29/2023. Licensee has landlord consent form to allow for 14 children in the FCCH.

Exit interview and review of this report was conducted with licensee. Notice of site visit and appeal rights were given. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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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