384002251-2-7-2023-05-CC-CQUO-CNTVGH-20230207152535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002251
Report Date: 02/07/2023
Date Signed: 02/07/2023 03:26:12 PM

Document Has Been Signed on 02/07/2023 03:26 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HAYWARD, JENNIFER		FACILITY NUMBER:	384002251
ADMINISTRATOR:	HAYWARD, JENNIFER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 469-8946
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94127
CAPACITY:	14	CENSUS: 12	DATE:	02/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Jennifer Hayward		TIME COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On February 7, 2023 at approximately 2:15pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Jennifer Hayward, and explained the purpose of the inspection. Present in the home were licensee, two assistant teachers (T1 and T2) and 12 enrolled children (all preschool age). Facility is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have criminal record clearance on file. Hours of operation are Monday to Friday 8:30am to 5:30pm. The home is a multi-level, single family home. The day care operates on the ground level of the home. Entrance to the day care is through the side gate, located on the right side of the home's garage. The DAY CARE AREAS are located on the ground level only which includes main classroom, bedroom #1 (play room), bathroom #1 and backyard. The OFF LIMIT AREAS are the garage, laundry room (ground level), office (ground level), and entire second level of home. Off limit areas are made inaccessible with child safety gates and/or child safety door handles. With licensee, LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Electrical outlets in day care areas were observed to be inaccessible. Home is equipped with a variety of age appropriate toys and materials that were in good working condition. LPA observed cleaning supplies, poisons and other chemicals to be stored inaccessible to children in home's high shelves and/or located in off limit areas. Bathroom was observed to be in proper working condition, equipped with appropriate sanitation materials. Home is equipped with a smoke and carbon monoxide detector, fully charged fire extinguisher and a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAYWARD, JENNIFER	FACILITY NUMBER: 384002251
	VISIT DATE: 02/07/2023

NARRATIVE

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The entire backyard is fully fenced and enclosed with an at least 5 ft. high fence. LPA observed backyard to have age appropriate materials and toys that were in good working condition. Backyard includes an age appropriate play structure that was observed to have resilient padding underneath. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 5 random children's files, which were complete. Children's files have a record of emergency identification information on file. LPA also reviewed licensee, T1 and T2's files which were also complete. Licensee, T1, and T2 have valid Mandated Reporter certifications and CPR certifications. Licensee's CPR certificate is current and will expire 06/2023. Emergency drills are conducted at least once every six months and are properly documented. Last emergency disaster drill was conducted 09/2022. Next emergency disaster drill is scheduled for 03/2023.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.

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/process

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAYWARD, JENNIFER	FACILITY NUMBER: 384002251
	VISIT DATE: 02/07/2023

NARRATIVE

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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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Due to no ink on LPA's printer, LPA was unable to provide hard copy of report to licensee. LPA will email a copy of the report to licensee. Licensee is required to acknowledge reciept of report.

Exit interview conducted and report was reviewed with the licensee, Jennifer Hayward.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

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