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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384005040
Report Date: 05/16/2025
Date Signed: 05/16/2025 01:15:38 PM

Document Has Been Signed on 05/16/2025 01:15 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:DEMURA, YELYZAVETAFACILITY NUMBER:
384005040
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/16/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Yelyzaveta DemuraTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 5/16/2025, at approximately 9:30AM, Licensing Program Analysts (LPAs) Tran and Garcia conducted an announced, pre-licensing inspection. LPAs met with Yelyzaveta Demura and explained the purpose of the visit.

The applicant states she lives on this property alone and has a cleared background check to be present in a childcare facility. Applicant rents this 2 bedroom, 2 bathroom home. Property Owner/Landlord Consent (LIC 9149) was submitted; therefore the maximum capacity is 8 children (two children must be school-age). Per applicant, there are no pets, open bodies of water or guns in the home.

The planned days of operation are Monday – Thursday from 8:00AM – 5:30PM and Fridays will be 8:00AM – 5:00PM. Per applicant, she will provide snacks, lunches, and dinners.

Day-care areas: Playroom #1 (living room), Playroom #2 (primary bedroom), Bedroom #1 (for napping purposes), Bathroom #1 (closest to Playroom #1), Kitchen, Art Room, and Backyard.

The off-limit areas: Bathroom #2 (split toilet/bath), Laundry Room, and Garbage Room.

Continued on Page Two
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2025
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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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: DEMURA, YELYZAVETA
FACILITY NUMBER: 384005040
VISIT DATE: 05/16/2025
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Page Two

With the applicant, LPAs inspected the property for health and safety hazards. The home has sufficient lighting and ventilation. There are a variety of age-appropriate toys and books for children. There are multiple dramatic playsets and kitchen toys. All furniture and playthings were observed to be in good repair. The property has a combo smoke/carbon monoxide detector and a fully charged fire extinguisher that is at least the size of 2A10BC. LPAs tested the smoke/carbon monoxide detector and verified functionality. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children.

There is a small stairway leading from Playroom #1 to the rest of the property. Childproof gates have been installed at the base and top of the stairs. Across from Bathroom #1, is a closet that applicant says she will use as her own closet. LPAs advised to install a childproof latch.

Doors leading to off-limit areas have childproof covers on the doorknobs. Applicant has covered all electrical outlets and sharp corners. Bedroom #1 has five cribs/pack and plays for napping purposes. LPAs observed no changing tables. LPAs reminded there must be a changing table available.

LPAs observed Bathroom #1 to be clean and free of debris. The cabinets have magnetic childproof locks on them. Per applicant, the split bath/shower and toilet rooms will not be used by her or children in care.

Playroom #2 has a bed, multiple toys for children, and a door leading to the backyard. Applicant states that she will use Playroom #2 as her primary bedroom and isolation area for when children get sick.

There is a childproof gate at the kitchen entryway. The laundry room and art room are accessed through the kitchen. The laundry room's door does not fully shut. LPAs advised to put a childproof latch on the door. The art room has multiple toys and age-appropriate books.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
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: DEMURA, YELYZAVETA
FACILITY NUMBER: 384005040
VISIT DATE: 05/16/2025
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The backyard has a variety of play structures and age-appropriate toys. There are many neighboring trees that provide shade for the children. There is a narrow pathway leading to a gate that opens to the main street. Per applicant, she plans to allow parents to pick up or drop off children through there if they are already in the backyard. Otherwise, the main front door will be primarily used. LPAs recommended a childproof gate be installed at the pathway.

There is a storage room accessible from the backyard. Applicant states that it is only for storing garbage bins.


Prior for approval of Small Family Child Care home, applicant must submit proof of the following items:
*Childproof latch installed on hallway closet
*Childproof latch installed on laundry room door
*Heating vents near the floor are blocked
*Changing table available
*Updated and signed property lease agreement

As of today's visit, 5/16/2025, licensure will be pending management review and approval. Follow up pre-licensing visit is required.

Exit interview conducted and report was reviewed with applicant, Yelyzaveta Demura.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC809 (FAS) - (06/04)
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