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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004457
Report Date: 01/07/2025
Date Signed: 01/07/2025 11:16:44 AM

Document Has Been Signed on 01/07/2025 11:16 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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MASSA, SHAYNA L.FACILITY NUMBER:
384004457
ADMINISTRATOR/
DIRECTOR:
MASSA, SHAYNA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 374-3327
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
01/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:32 AM
MET WITH:Shayna MassaTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On 1/7/2025, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit and met with the Licensee, Shayna Massa. LPA explained the purpose of the visit to the licensee.

Two infants and one pre-k child were present during today’s visit. One eleven-year-old child was present, and children over the age of ten are exempt from the ratio. The three adults caring for the children received criminal record clearance from the California Department of Social Services, and the one other adult in the home also received criminal record clearance from the department. The licensee holds a large license and is within capacity limits and ratios for today’s visit.

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.

The most recent emergency disaster drill was conducted on 4/10/2024, and the LPA observed that it was documented. LPA reviewed the emergency disaster drill log and found that the last emergency drill had not been completed in the last six months. LPA reminded the licensee to conduct an emergency drill promptly and to document it once completed.

Daycare Areas: the entire ground level and backyard.

Off-limit Areas: the entire first and second levels and garage. The licensee 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 has two fire extinguishers, a first aid kit, and multiple combo carbon monoxide/smoke detectors. LPA observed that the home's interior was clean and orderly, with proper heating and ventilation. Disinfectants, cleaning solutions, poisons, and other hazardous items were stored in areas inaccessible to children. The bathroom was clean, fully operational, and equipped with suitable toileting equipment and sanitation products.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MASSA, SHAYNA L.
FACILITY NUMBER: 384004457
VISIT DATE: 01/07/2025
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LPA observed that the daycare areas had age-appropriate toys, furniture, and educational materials. Electrical outlets were fitted with child safety covers. A child safety gate was observed at the backyard stairs to prevent access to other parts of the home. Child safety locks were observed on the kitchen stove knobs. A small fish tank was present and had a cover on it. According to the licensee, there are no firearms or weapons 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. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with artificial grass. LPA did not observe any other pools, spas, or bodies of water on the property.

The licensee currently provides lunch and snacks for the children in their care. According to the licensee, none of the enrolled children has a documented allergy.

The facility offers different options for children to rest or nap, including mats, cribs, and cots. LPA observed that sheets and blankets were available for the children. Infant mattresses are firm and equipped with appropriately sized sheets. All cribs are well-maintained and free of loose items that could pose safety risks.

LPA reviewed the files of three children and verified that their emergency contact and medical information were complete. LPA also reviewed the two children’s 15-minute sleep records, which are required for children under the age of two, and found that they were documented.



LPA reviewed three staff files and confirmed that all required forms were present. LPA found that the licensee has a current Pediatric First Aid/CPR certification, which will expire in May 2025.

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

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MASSA, SHAYNA L.
FACILITY NUMBER: 384004457
VISIT DATE: 01/07/2025
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LPA discussed the safe sleep regulations with 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 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.

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.

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

Exit interview conducted and report was reviewed with the Licensee, Shayna Massa.

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

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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