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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216267
Report Date: 03/12/2025
Date Signed: 03/13/2025 07:17:49 AM

Document Has Been Signed on 03/13/2025 07:17 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/
DIRECTOR:		JANA HELENE CLARKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 714-9381
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/12/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Jana ClarkTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On March 12, 2025, at 12:15 PM, Licensing Program Analyst (LPA) Gigi conducted an unannounced Annual Random inspection at the above Family Childcare Home (FCCH). LPA met with Licensee, Jana Clark and Assistant, Maria delos Angeles Garcia. The FCCH operating hours are Monday to Friday, 7:00 AM to 5:00 PM. Licensee provides care to children 0 to 12 years old

During the inspection, LPA and Licensee toured the inside and outside of the home. LPA observed 9 children, 2 of whom are infants under the supervision of licensee and assistant. On or about 1:20 PM, another assistant arrived. Few minutes later, licensee left to pick up a school age child and returned within 5 minutes bringing a total number of children in care to 10 .The Accessible area in the home includes living room, playroom, dining, kitchen, one bedroom, one bathroom and fenced backyard. Kitchen cabinets are equipped with child safety locks. The 3 bedrooms and garage remain inaccessible. Bedroom doors have attached plastic knobs to prevent access by day care children.

The required licensing forms are posted in the prominent location. LPA observed age-appropriate toys and equipment inside the home.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/12/2025
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The outdoor space is free of any tripping hazards, age-appropriate play structure and toys were also observed. Knives and cleaning materials are stored inaccessible to the children in care. The bathroom for children’s use is free of toxins.

LPA reviewed the facility and found that the Pediatric CPR and First Aid certificate expires on 2/2026 while Mandated Reporter Training Certificate expires on 4/3/2026. LPA reminded Licensee that it is their responsibility to renew the certificates every two years. The regulation fire extinguisher was serviced on 4/3/2024. Combination carbon monoxide and smoke detectors were observed in the home. FCCH conducts fire and disaster drill every 6 months and last drill was conducted on 11/15/2024.

Children’s files were reviewed and found complete. Licensee checks and documents napping infants every 15 minutes. Individual Safe Sleep Plans are completed for infant 0-12 months old. Nobodies of water was observed. Licensee confirmed there are no firearms and ammunition 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.

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

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CLARK FAMILY CHILD CARE
FACILITY NUMBER: 426216267
VISIT DATE: 03/12/2025
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Licensee is not providing Incidental Medical Services (IMS). 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/.

Control of Property was reviewed, Property Owner Consent (LIC 9149) and Landlord Notification (LIC 9151) are on file.

During the exit interview, the LICENSEE, Jana Clark confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.


During today’s inspection, no deficiency was cited.

Notice of Site Visit was issued and must be posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Jana Clark

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CLARK FAMILY CHILD CARE
FACILITY NUMBER: 426216267
VISIT DATE: 03/12/2025
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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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed licensee, 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.

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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