<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001758
Report Date: 03/19/2025
Date Signed: 03/19/2025 05:29:55 PM

Document Has Been Signed on 03/19/2025 05:29 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:HARRIS, MARLISFACILITY NUMBER:
384001758
ADMINISTRATOR/
DIRECTOR:		HARRIS, MARLISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 751-7977
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
03/19/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:53 PM
MET WITH:Karina Vasilevska-DasTIME VISIT/
INSPECTION COMPLETED:
05:30 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 March 19, 2025, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit. LPA met with the Licensee’s Assistant, Karina Vasilevska-Das (S1), and explained the purpose of the visit. On January 23, 2025, LPA attempted to conduct an annual visit, however, the licensee was leaving the house to meet the daycare children at a park. The licensee was not present during today’s visit, and according to S1, she’s on vacation and will not return until the second week of April 2025.

Today’s visit included five pre-k children. S1 had obtained criminal record clearance from the California Department of Social Services. The facility operates within this visit's capacity limits and ratios.

Per S1, the facility has ten children enrolled in the daycare.

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed and visible to the public.

LPA reviewed the emergency disaster drill log and found the last documented emergency disaster drill was on November 22, 2023. The facility will be issued a technical violation for not conducting an emergency disaster drill every six months.

Daycare Areas: the living room, the kitchen/dining area, the bathroom, the bedroom toward the backyard, and the backyard

Off-limit Areas: The garage. S1 understands that off-limits areas may not be used for childcare during business hours.

LPA inspected the indoor and outdoor daycare areas to identify health and safety hazards. The home had a fire extinguisher, a first aid kit, a carbon monoxide detector, and two smoke detectors.

See Page 2

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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 7
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: HARRIS, MARLIS
FACILITY NUMBER: 384001758
VISIT DATE: 03/19/2025
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
26
27
28
29
30
31
32
Page 2

LPA observed that the home's interior was clean and orderly. Disinfectants, cleaning solutions, poisons, and other hazardous items were stored in areas inaccessible to children. LPA observed that the bathroom toilet and sinks had been removed, and according to S1, they had been unavailable since last week. Potty chairs were available for the children.

LPA observed that the daycare areas had age-appropriate toys, furniture, and educational materials. The fireplace was plastered with a layer of concrete. Electrical outlets were fitted with child safety covers to prevent children's access.

According to S1, there are no firearms or weapons were present on the property.

The backyard is surrounded by a fence and features a variety of outdoor play equipment, all of which are in excellent condition. LPA did not observe any pools, spas, or bodies of water on the property

LPA reviewed the files of five children and confirmed that all necessary forms were present and completed for each child.

LPA reviewed S1 files and confirmed she did not have a valid Pediatric First Aid/CPR certification. All other S1’s records were complete. LPA also reviewed S1’s Mandated Reporter Training and found she did not complete the correct course. The facility was issued a technical violation for not completing the correct Mandated Reporter Training.

Facility representative 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.

See Page 3

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: HARRIS, MARLIS
FACILITY NUMBER: 384001758
VISIT DATE: 03/19/2025
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
26
27
28
29
30
31
32
Page 3
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 facility representative 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 facility representative 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.

Facility Representative 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 facility representative, Karina Vasilevska-Das, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

At 4:05 p.m., S1 had to leave the facility to pick up her child, and LPA left the facility to complete the report.

LPA Hanson Leong placed today’s report in the licensee’s mailbox, dated 3/19/2025, documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

See Page 4

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: HARRIS, MARLIS
FACILITY NUMBER: 384001758
VISIT DATE: 03/19/2025
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
26
27
28
29
30
31
32
Page 4
Also, LPA Hanson Leong placed a copy of this licensing report in the licensee’s mailbox dated 3/19/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

TECHNICAL VIOLATION: Violations of the Health and Safety Code (HSC), regulations (CCR), or interim licensing standards (ILS) that do not pose a health, safety or personal rights risk.

Please refer to LIC 809D for today’s deficiency.

Today’s report and the facility’s appeal rights were dropped off in the licensee’s mailbox.

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

LPA was unable to obtain a signature for today's report.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 03/19/2025 05:29 PM - It Cannot Be Edited


Created By: Hanson Leong On 03/19/2025 at 05:01 PM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HARRIS, MARLIS
FACILITY NUMBER: 384001758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above. The licensee's assistant was carding for five children and did not have a valid CPR and First Aid certification, which poses an immediate health, safety or personal rights risk to children in care.
POC Due Date: 03/20/2025
Plan of Correction
1
2
3
4
The licensee's assistant said she would take a CPR and First Aid class immediately and submit proof of completion to the department the by the deadline mentioned above.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Garfield Leung
LICENSING EVALUATOR NAME:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2025


LIC809 (FAS) - (06/04)
Page: 5 of 7