384002251-1-16-2025-05-CC-JTSE-DCZ3CS-20250116170826

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002251
Report Date: 01/16/2025
Date Signed: 01/16/2025 05:08:38 PM

Document Has Been Signed on 01/16/2025 05:08 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/ DIRECTOR:	HAYWARD, JENNIFER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 469-8946
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 9	DATE:	01/16/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:35 PM
MET WITH:	Licensee, Jennifer Hayward		TIME VISIT/ INSPECTION COMPLETED:	05:25 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 1/16/2025, at approximately 3:35PM, Licensing Program Analyst (LPA) Jonathan Tse arrived at the facility to conduct an unannounced annual visit. LPA met with Licensee, Jennifer Hayward and explained the purpose of the visit. Present during the visit was Licensee, three helpers, and nine preschool age children. The facility is operating within staffing and ratio requirements on this day. The facility’s hours of operation are from 8:30AM to 5:30PM, Monday to Friday. Daycare Areas: Playroom, Bedroom, Bathroom, Backyard Off-limits Areas: Laundry Room, Office, Garage, and the entire Upper Level. LPA and Licensee inspected the facility for any health or safety hazards. The facility is equipped with a fully charged 2A10BC fire extinguisher. There is an operational carbon monoxide detector present in the Laundry Room. Electrical outlets are covered or blocked by furniture when not in use. Stairs are blocked off and kept inaccessible to children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. There is a first aid kit present in the Playroom. LPA observed there to be age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. There are cubbies available for each child. Children nap on mats that cleaned every week or as needed. Children bring bedding from home. Per Licensee, bedding is cleaned at the facility and taken home during long breaks. Children bring lunch from home and the facility provides snacks. The facility provides sippy cups for children in care. Water is available and refilled as needed. Continued on Page Two

Ali Zebila	TELEPHONE: (650) 266-8817
Jonathan Tse	TELEPHONE: (650) 464-4927
	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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: 01/16/2025

NARRATIVE

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LPA observed the Backyard to be enclosed by a fence that is at least four feet high. There are age-appropriate toys and equipment available for use. The surface of the Backyard is cushioned with artificial turf. There is a play structure present. There is a sandbox that is checked daily and raked weekly. There are no swimming pools or other similar bodies of water present in the facility. Per Licensee, there are no firearms or weapons stored in the facility.

LPA reviewed four staff files, nine children’s files, and facility records. Licensee’s Pediatric First Aid/CPR is current and expires 1/2026. Licensee’s Mandated Reporter Training expires 2/2025. All adults living or working in the home have acquired fingerprint clearance and are associated to the facility. All children’s files were observed to be complete. The facility last conducted an emergency drill on 10/2024. Emergency drills are properly logged and documented. All required postings were observed to be posted and accessible for review upon entry to the Playroom.

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.

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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: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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: 01/16/2025

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-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.

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 1/16/2025.
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: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC809 (FAS) - (06/04)

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