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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020198
Report Date: 07/18/2023
Date Signed: 07/18/2023 12:35:08 PM

Document Has Been Signed on 07/18/2023 12:35 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CLARK FAMILY CHILD CAREFACILITY NUMBER:
198020198
ADMINISTRATOR:BRIANNA CLARKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 344-1306
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 8DATE:
07/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Brianna ClarkTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Crystal Green conducted an unannounced required 1 year inspection. LPA met with Licensee, Brianna Clark, who guided analyst on a tour of the facility. Also present during this inspection was Licensee’s Assistant, Chalette Coates and Gladys Clark. During this inspection, there were 8 children present which 4 were infants. Licensee states that there are currently 14 children enrolled.

This is a one-story home which consists of 2 bedrooms, 1 bathroom, kitchen, dining room, living room (Fireplace: inaccessible), front yard, backyard (fenced) and ADU/ garage (playroom). The children use the bathroom, living room, backyard, and ADU/garage (playroom). Per licensee, areas off limits to children and parents include: 2-bedroom, kitchen, dining room, and front yard. The LPA toured all areas used by children during this visit. The parents provide food for their child in care.

Family members residing in the home are one adult and four children (criminal record clearances on file). 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.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating or safety and comfort. There were safe toys, play equipment and materials observed for children. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children should be made inaccessible.
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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CLARK FAMILY CHILD CARE
FACILITY NUMBER: 198020198
VISIT DATE: 07/18/2023
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Per licensee, there are no weapons, firearms on the premises. There is one small dog on the premises that remains in the off-limit bedrooms during operating hours. Children’s records were reviewed to ensure that each child has an Identification and Emergency form and copy of their Immunization Record’s. The valve on the required 2A 10BC fire extinguisher indicates fully charged, date of purchase 05/05/2023. LPA tested the smoke detector and carbon monoxide detector located in the kitchen, which was observed to be in operable condition. LPA reviewed Licensee Pediatric First Aid and CPR, which was observed to expire on 03/17/2025.

The licensee provided proof of control of property. Because the licensee rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA observed and inspected sleeping equipment for infants. LPA observed a crib and a play yard available for infant children who is unable to climb out of the crib or play yard. 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 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.

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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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CLARK FAMILY CHILD CARE
FACILITY NUMBER: 198020198
VISIT DATE: 07/18/2023
NARRATIVE
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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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, no citations are being issued today.

Exit interview conducted and report was reviewed with the licensee and appeal rights were provided.

A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.









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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC809 (FAS) - (06/04)
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