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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410519059
Report Date: 03/30/2022
Date Signed: 03/30/2022 04:44:38 PM


Document Has Been Signed on 03/30/2022 04:44 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KERMANI-CARY, SHEILAFACILITY NUMBER:
410519059
ADMINISTRATOR:KERMANI-CARY, SHEILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 742-0471
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:14CENSUS: 11DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sheila Kermani-CaryTIME COMPLETED:
04:30 PM
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On March 30, 2022, Licensing Program Analysts (LPA), Leong, conducted an unannounced annual inspection with Sheila Kermani-Cary. LPA explained the inspection's purpose to the licensee. During today's inspection, two infants and nine pre-k children were in the care of the licensee and one staff member. The fingerprint clearance is on file for all adult residents. The daycare operates from 7:30 am -5:30 pm, Monday through Friday.

The daycare areas include a classroom, bathroom #3, playroom, and side/back yard. The off-limit areas include the main house garage, bedroom #1, #2, #3, bathroom #1, #2, kitchen, and dining room. All off-limit areas are properly barricaded. When a child exhibits symptom of illness, the Licensee will separate the child in one of the rooms while contacting the parent to arrange for the child's pick-up

LPA and the Licensee conducted an inspection of the daycare areas to look for potential health and safety hazards. The daycare is outfitted with age-appropriate toys and equipment. The home is well-lit, well-ventilated, and free of defects or conditions that endanger children in care. The daycare is equipped with a smoke detector, carbon monoxide detector, and a fully charged fire extinguisher. All the electrical outlets and trash cans are covered. Children have access to first aid supplies. Cleaning compounds, detergents, and other items that could endanger children are kept out of reach of children.
*** See Page 2 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KERMANI-CARY, SHEILA
FACILITY NUMBER: 410519059
VISIT DATE: 03/30/2022
NARRATIVE
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Playpens, which include mattresses are available for infants to use for napping. Resting mats are available for pre-k children to use for napping. Sleeping behavior for each infant is documented every fifteen minutes. LPA saw no walkers, bouncers, or other similar items. The backyard is fenced, clean, and equipped with age-appropriate outdoor equipment. The play structure was surrounded by grass to absorb any child falls. According to the Licensee, there are no firearms or weapons on the premises. LPA observed that there were no pools, spas, or other bodies of water in the home.

LPA observed that the Licensee had posted all the required forms, including the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in family childcare homes.

During the inspection, LPA went over all the children's records. Each child has an emergency information card in their file that includes their full name, phone number, and the location of a parent or other responsible adult who can be contacted in an emergency. Each child's file contained parental authorization for the Licensee or registrant to consent to emergency medical care, as well as the child's physician's name and phone number. Every six months, fire and earthquake drills are held and documented.

***See Page 3 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KERMANI-CARY, SHEILA
FACILITY NUMBER: 410519059
VISIT DATE: 03/30/2022
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LPA reviewed all staff records. Both licensee and one staff member maintain a current Pediatric First Aid and CPR certification. Additionally, LPA met with the Licensee to discuss supervision and capacity expectations/requirements. Although the Licensee does not transport children, she is aware that children should never be left in vehicles unattended.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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.

***See Page 4 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KERMANI-CARY, SHEILA
FACILITY NUMBER: 410519059
VISIT DATE: 03/30/2022
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The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPAs reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPAs encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.


A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Sheila Kermani-Cary.

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

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4