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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380506144
Report Date: 09/01/2021
Date Signed: 09/01/2021 03:08:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2021 and conducted by Evaluator Farhan Bashir-Tariq
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210614165148
FACILITY NAME:JENKINS, CAROLFACILITY NUMBER:
380506144
ADMINISTRATOR:JENKINS, CAROL A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 554-0559
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY:12CENSUS: 4DATE:
09/01/2021
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Carol JenkinsTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Child sustained an injury while in care.
INVESTIGATION FINDINGS:
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On 9/01/21 at 1:45 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to deliver the findings of this complaint investigation. Purpose of inspection was explained. There were four infants present today with Licensee. Licensee was working in compliance to staff and children ratio requirement. On 6/21/21, LPA made an initial inspection to start the investigation of this complaint via phone due to COVID-19 restrictions. A subsequent on-site inspection was conducted today to deliver the findings. LPA toured child care play area with Licensee today. During the course of investigation, interviews were conducted with Licensee and parents. As part of this investigation, copies of facility rosters were collected from Licensee via email.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 05-CC-20210614165148
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JENKINS, CAROL
FACILITY NUMBER: 380506144
VISIT DATE: 09/01/2021
NARRATIVE
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This agency has investigated the complaint alleging that child sustained an injury while in care. Based on the information obtained, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No citations were issued on this report. This report must be available in the facility for public review. Facility was advised to call office for any additional questions, M - F, 8 AM-5 PM at 650-266-8800. Website: www.cdss.ca.gov






















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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
LIC9099 (FAS) - (06/04)
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