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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214200171
Report Date: 02/01/2024
Date Signed: 02/01/2024 12:00:40 PM


Document Has Been Signed on 02/01/2024 12:00 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SAMAN, EDNAFACILITY NUMBER:
214200171
ADMINISTRATOR:SAMAN, EDNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 250-9097
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:14CENSUS: 10DATE:
02/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Edna SamanTIME COMPLETED:
12:10 PM
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On 2/1/2024, Licensing Program Analyst (LPA) Hanson Leong made an unannounced required visit to the Family Childcare Home listed above. The LPA was granted entry by the Licensee, Edna Saman. The licensee was informed of the reason for today's visit by the LPA. Present in the home included the licensee, the licensee’s assistant, the licensee’s father, seven preschool-aged children, and three infants, All individuals present in the home have fingerprint clearance to work or be in a family childcare home. The home operates within its capacity and in accordance with the required ratio of staff to children.

Day-care Areas: Living room (indoor play/ activity area), Bathroom (Hallway), Nap room, and Backyard.

Off-Limit Areas: Upstairs, Kitchen, two Bedrooms on the lower level, and a separate room in the back (behind the kitchen). All off-limit areas are secured with a locked door or a safety gate. The licensee understands that off-limits areas may not be used for childcare during business hours.



LPA and the licensee carried out an inspection to identify any possible hazards to health and safety. Toys and equipment suitable for children of the proper age range are provided at the daycare. The LPA observed that the playground equipment and outdoor furnishings appeared to be in excellent condition. The building has sufficient lighting and ventilation and is free of any defects or conditions that put children at risk. The home provides a first aid kit that contains all necessary supplies for wound care and other injuries. The home has a smoke detector, a carbon monoxide detector, and a 3A40BC 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. According to the licensee, no firearms or other weapons are on the premises. The LPA found that the home did not have any pools, spas, or other bodies of water of any kind. The LPA observed there was a fireplace in the home, which was properly secured with a cover.
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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAMAN, EDNA
FACILITY NUMBER: 214200171
VISIT DATE: 02/01/2024
NARRATIVE
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The 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.

The LPA observed that all required documents were displayed in the home, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist. The facility’s most recent emergency disaster drill was conducted on 9/15/2023 and was properly recorded, as confirmed by the LPA's review of the log.



The LPA reviewed the records of both the children and staff members. The LPA found that the licensee carries childcare insurance with Hays Companies, Inc. The 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. The LPA reviewed the sleeping records for children under two and confirmed that the data had been correctly recorded. Following a review of the staff records, the LPA found the licensee and the licensee’s assistant possess a current certification in Pediatric First Aid/CPR and Mandated Reporter. The licensee’s Pediatric First Aid/CPR certification expires on 12/2024.

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/.


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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAMAN, EDNA
FACILITY NUMBER: 214200171
VISIT DATE: 02/01/2024
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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.

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 2/1/2024, 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: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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