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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416771
Report Date: 01/06/2023
Date Signed: 01/06/2023 11:08:36 AM

Document Has Been Signed on 01/06/2023 11:08 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 JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CARROLL, JILLFACILITY NUMBER:
274416771
ADMINISTRATOR:JILL, CARROLLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 578-9970
CITY:SALINASSTATE: CAZIP CODE:
93908
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
01/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Jill CarrollTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Joe Macias conducted an announced Prelicensing Inspection. The LPA met with the Applicant Jill Carroll and disused the nature of today's inspection. The purpose of today’s inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Todays census is 4, upon arrival LPA observed 4 children (1 infants, 3 preschool age) present, the Applicant will receive a deficiency for providing unlicensed care. Unlicensed care was discussed with the Applicant. The Applicant and her husband Barry Carroll are the only adults who reside in the home. The hours of operation are Monday - Friday, 8am - 5pm. The Applicant's CPR and First Aid are current, and expire May 2023. The Applicant has completed the Lead Poisoning Prevention Training. Applicant may obtain liability insurance upon receiving her license.

No person, firm, partnership, association, or corporation shall operate, establish, conduct, or maintain a child care facility in this state without a current valid license.



Type B deficiency cited for unlicensed care. Exit interview conducted and report was reviewed with the Applicant Jill Carroll. The Applicant was advised that a large family child care license will be issued pending management approval.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
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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Document Has Been Signed on 01/06/2023 11:08 AM - It Cannot Be Edited


Created By: Joseph Macias On 01/06/2023 at 10:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CARROLL, JILL
FACILITY NUMBER: 274416771

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2023
Section Cited
HSC
1596.80

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Unlicensed Care:
No person, firm, partnership, association, or corporation shall operate, establish, conduct, or maintain a child care facility in this state without a current valid license, therefore, provided in this act.
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Unlicensed care was discussed, the Applicant has submitted an application. All adults who reside in the home are cleared and associated to the pending license. The Applicant will cease to provide care to more than one family until she has received her license.
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Upon arrival LPA observed 4 children (1 infants, 3 preschool age) present. This poses a potential risk to the health, safety, and personal rights of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Joseph Macias
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023


LIC809 (FAS) - (06/04)
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