384002251-2-27-2024-05-CC-JTSE-D2V2DB-20240227161805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002251
Report Date: 02/27/2024
Date Signed: 02/27/2024 04:18:17 PM

Document Has Been Signed on 02/27/2024 04:18 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
SAN BRUNO CC RO, 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: 9	DATE:	02/27/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Licensee, Jennfier 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 2/27/2024, at approximately 2:00PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Jennfier Hayward. LPA explained the purpose of the visit. Present during the visit was the Licensee, two helpers (H1 and H2), and nine preschool age children. The facility’s operating hours are from 8:30AM to 5:30PM. Daycare Areas: Playroom, Bedroom, Bathroom, Backyard Off-limits Areas: Laundry Room, Office, Garage, and the entire upper level. LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. Electrical outlets are covered or obstructed by furniture to be inaccessible to children in care. There are cubbies available for each child. There is a fully charged 2A10BC fire extinguisher present in the home. Licensee demonstrated the carbon monoxide detector to be operational. LPA observed age-appropriate toys and learning materials to be present in the Playroom and the Bedroom. Mats are stored in the Bedroom. Bedding is provided from home and is taken home to be cleaned once a week. Children bring lunch from home and the facility provides morning and afternoon snacks. Per Licensee, there are no firearms present in the facility. LPA observed the Backyard to be free of debris and other loose articles. The Backyard is enclosed by a fence that is at least five feet high. There is an age-appropriate play structure that has railings. Underneath the play structure is a sand pit that is checked daily and cleaned every week. There are age-appropriate toys and equipment for children in care. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAYWARD, JENNIFER	FACILITY NUMBER: 384002251
	VISIT DATE: 02/27/2024

NARRATIVE

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LPA reviewed three personnel files and five children’s files. Licensee’s First Aid/CPR expires on 1/2026. Licensee’s Mandated Reporter Training expires on 2/2025. All children’s files were observed to be complete and included Identification and Emergency Information (LIC700), Consent for Emergency Medical treatment (LIC627), Notification of Parents’ Rights (LIC995), and complete immunization records. Required postings were observed to be posted in the entryway of the facility.

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. 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-andresources/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.

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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAYWARD, JENNIFER	FACILITY NUMBER: 384002251
	VISIT DATE: 02/27/2024

NARRATIVE

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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/.

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.

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

No deficiencies were cited under CCR Title 22, Division 12 during today’s visit on 2/27/2024.
A notice of site visit was given and must remain posted for 30 days.

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

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC809 (FAS) - (06/04)

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