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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214200171
Report Date: 04/24/2025
Date Signed: 04/24/2025 03:22:48 PM

Document Has Been Signed on 04/24/2025 03:22 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:SAMAN, EDNAFACILITY NUMBER:
214200171
ADMINISTRATOR/
DIRECTOR:		SAMAN, EDNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 250-9097
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/24/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Edna SamanTIME VISIT/
INSPECTION COMPLETED:
03:41 PM
NARRATIVE
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On April 24, 2025, Licensing Program Analyst (LPA) Jaclyn Naves conducted an unannounced annual inspection to the home listed above. LPA was greeted by licensee Edna Saman and the reason for today’s visit was explained and was granted entry by the licensee. Present in the home today were licensee assistant and her father 11 children (7 school age and 4 infants). All adults present today have fingerprint clearance to be able to work and be in the child care home. Licensee meets operational capacity requirements and is in accordance with the required ratio of staff to children during todays visit.

Day Care Areas: Living room (indoor play area), hallway bathroom ,nap room, outdoor play area.

Off-Limit Areas: Entire second level of home, Kitchen, two bedrooms on first floor, separate room in backyard area (behind kitchen) and car port/garage.

All off-limit areas are properly gated off and secured with locks. Licensee understand that off limit areas are not to be used for childcare during operating business hours.

LPA observed all required postings were prominently hung in the entry of home in a place visible to parents, Facility license, Notification of Parents rights, and Earthquake Preparedness Checklist. Licensee conducted last emergency drill on 3/11/2025 and was properly logged, and reviewed by LPA. Licensee conducts emergency drills every 6 months.


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Ali ZebilaTELEPHONE: (650) 266-8817
Jaclyn NavesTELEPHONE: (650) 266-8800
DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: SAMAN, EDNA
FACILITY NUMBER: 214200171
VISIT DATE: 04/24/2025
NARRATIVE
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LPA and licensee toured both the indoor and outdoor child care areas and inspected for any possible hazards to health and safety of the children in care. LPA observed various toys and equipment for children for various ages to be in excellent condition. No broken or damaged toys were observed. The outdoor area has a variety of bikes, slides, cars and a playhouse all in excellent condition. The outdoor area has a sink and the entire ground has padding to prevent injury from falls that is not cracked or damaged. There is adequate shade from a covering that hangs across play area.

The home has adequate light and ventilation, and the temperature is pleasant and free of any defects that could put children at risk. Licensee provides all meals and snacks for children in care breakfast lunch and snack.The home has a first aid kit equipped with all necessary supplies for wound care and other injuries. Two smoke and carbon monoxide combination detectors were in the home as well as a fully charged fire extinguisher.

All garbage cans and power outlets have been appropriately covered. Products used for cleaning and washing, along with any other materials that could potentially harm children, are kept safely out of their reach. During today's inspection, the LPA found no walkers, bouncers, or comparable objects.

LPA observed a designated area for children to sleep or rest quietly. The area includes sleeping mats, pillows, blankets, and sleeping playpens for each child. The LPA observed one diaper-changing station in the home, which is clean and safe for the children to use. Baby wipes and diapers were available for the children in care. Licensee provides bedding for children and washes them weekly or as needed.

LPA reviewed the records of the licensee and her assistant. All required forms were in the files of the licensee and her assistant. A review of the licensee's training records reveals that she and her assistant are both up to date with their Pediatric First Aid / CPR certifications (exp 12/2026) and Mandated Reporter Training (exp 11/18/2025) as well as their complete immunizations and Flu shots. LPA reviewed the five children's records and found that their files contain all necessary documents, including their Immunization Record, Identification/Emergency Information, Consent for Emergency Medical Treatment, and Notification of Parents’ Rights. LPA reviewed the sleeping logs for children under two and confirmed that the data had been correctly recorded. LPA found that the licensee carries liability childcare insurance with Hays Companies, Inc.



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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jaclyn NavesTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: SAMAN, EDNA
FACILITY NUMBER: 214200171
VISIT DATE: 04/24/2025
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According to the licensee, no firearms or other weapons are on the premises. The licensee is aware that smoking is not permitted in a family childcare facility. The LPA observed there was a fireplace in the home, which was properly barricaded and inaccessible to children.

LPA found that the home did not have any pools, spas, or other bodies of water of any kind.

LPA and licensee discussed 80/20 expectation and licensee understood.

The 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.

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/.



LPA discussed the safe sleep regulations with the 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 the 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 ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jaclyn NavesTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: SAMAN, EDNA
FACILITY NUMBER: 214200171
VISIT DATE: 04/24/2025
NARRATIVE
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The 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, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On 4/24/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

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.

No deficiencies were issued today during LPA's visit.

A copy of today's report was given to Edna Saman.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Edna Saman.

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jaclyn NavesTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5