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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506144
Report Date: 02/28/2024
Date Signed: 02/28/2024 10:43:45 AM

Document Has Been Signed on 02/28/2024 10:43 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
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: 12TOTAL ENROLLED CHILDREN: 2CENSUS: 1DATE:
02/28/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Licensee, Carol JenkinsTIME COMPLETED:
11:00 AM
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On 2/28/2024, at approximately 8:50AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Carol Jenkins. LPA explained the purpose of the visit. Present during the visit was the Licensee and one infant. The facility is in compliance with capacity requirements on this day.

Daycare Areas: Living Room and Half-Bathroom located on the ground level.
Off-limits Areas: Entire upper levels. Bedroom, Kitchen, Bathroom and Garage in the ground level.

LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged 2A10BC fire extinguisher. There is a carbon monoxide detector that was demonstrated to be operational. LPA observed age-appropriate toys and learning materials to be present in the Living Room. The stairs leading to the lower level are secured by a childproof gate. Poisons, detergents, and other chemicals are stored inaccessible to children in care.

There is no outdoor play area in the facility. Per Licensee, children are taken on short walks to local parks or libraries. There are no pools or other bodies of water present. Per Licensee, there are no weapons or firearms in the home. There is a pet dog that only stays in the off-limits areas.

LPA reviewed personnel records and two children’s files. Licensee’s First Aid/CPR expires on 12/2024. Licensee’s Mandated Reporter Training expires on 12/2024. LPA observed all children’s files to be complete. Children’s files contained Emergency Identification and Emergency (LIC700), Consent for Emergency Medical Treatment (LIC627), Notification of Parents’ Rights (LIC995) and complete immunization records. LPA discussed the requirement to maintain infant sleep logs with Licensee.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: JENKINS, CAROL
FACILITY NUMBER: 380506144
VISIT DATE: 02/28/2024
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LPA observed all required postings to be visible and accessible for review. The last emergency drill was conducted on 1/31/2024. All emergency drills are properly logged and documented. Per Licensee, lunch and snacks are provided for children in care.

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 assesed 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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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: JENKINS, CAROL
FACILITY NUMBER: 380506144
VISIT DATE: 02/28/2024
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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 during today’s visit on 2/28/2024.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Carol Jenkins.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4