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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384005040
Report Date: 06/11/2026
Date Signed: 06/11/2026 02:55:18 PM

Document Has Been Signed on 06/11/2026 02:55 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: 6CENSUS: 5DATE:
06/11/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Licensee, Yelyzaveta DemuraTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On June 11, 2026, at approximately 11:15AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced, annual inspection. LPA met with licensee, Yelyzaveta Demura, and explained the purpose of the visit. Present during LPA’s visit included licensee and 5 children (3 infants and 2 preschool age children). Licensee is a small license and is operating within capacity limits and ratio during LPA’s visit. The facility's hours of operation are Monday to Thursday from 8:00AM to 5:30PM and Friday from 8:00AM to 5:00PM.

Licensee lives in the ground level unit in a 2-unit building. Licensee has fingerprint clearance on file.

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

Off-limit areas: Bathroom #2 (split toilet/bath), Laundry Room, Garbage Room and outdoor side hallway.

Off-limit areas have been made inaccessible with child safety gates and devices.


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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2026
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: 06/11/2026
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LPA inspected the facility for health and safety hazards. LPA observed home to be in good condition and free of debris. Home is equipped with a fully charged 3A40BC fire extinguisher, a fully stocked first aid kit, and multiple smoke and carbon monoxide detectors. Heating vents have been secured with a mesh cover. Stairs have child safety gates installed at the top and bottom steps. Poisons, chemicals, and cleaning detergents have been made inaccessible. Per licensee, there are no weapons or firearms in the home.

LPA observed electrical outlets to be made inaccessible with child safety covers. Flooring in the home includes soft padding that is clean and in good condition. LPA observed the home to have a variety of toys and equipment that are age appropriate. Children have access to books, manipulatives, and dramatic play materials. There are also areas for rest and relaxation.

Licensee provides a food service that includes breakfast, snacks, lunch, and an early dinner. Children eat in the Kitchen in highchairs. Reusable utensils and plates are utilized for children that are sanitized daily. Drinking water is available from tap and given to children in their water bottles. Per licensee, no enrolled children have allergies.

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/.

Bathroom for children’s use was observed to be in working condition and is equipped with age-appropriate toileting equipment. LPA observed the cabinets in the bathroom to have child safety locks installed. There is a diaper changing table in the Nap Room. Per licensee, children’s families provide their own diapers and wipes. LPA observed diapers and children's materials to be appropriately stored. There are multiple garbage bins with tight fitting lids in the home to dispose of dirty diapers.

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

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
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: 06/11/2026
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Children sleep in cribs and pack and plays. Licensee provides all bedding materials for children. Per licensee, linens are laundered by them every two weeks. Licensee maintains sleeping logs for napping infants. LPA observed sleeping logs to include the 15 minute time stamp of when the infant is checked on while napping and their sleeping position.

LPA discussed with licensee about having older children transition to sleeping mats as children gain the ability to climb out of cribs/pack and plays by themselves. Licensee stated that they understood.

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.

Backyard is fully enclosed and fenced. The backyard has thick rubber mats on the ground to cushion falls. There are a variety of outdoor toys and materials that are age appropriate. A large tarp provides shade for children to play under. The Garbage Room can be accessed from the backyard and LPA observed it to be locked. LPA did not observe any pools, spas or bodies of water on site.

Licensing documentation is properly posted and made available for review by the front entrance. A childcare roster was also made available for LPA's review. Emergency disaster drills are conducted and are appropriately documented. The last disaster drill was conducted on June 1, 2026. Licensee's Mandated Reporter certification is current and will expire in May 2027. Licensee's CPR is also current and will expire in October 2027. Licensee has required immunizations on file. Licensee does not currently carry childcare liability insurance.

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

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
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: 06/11/2026
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LPA reviewed children's records. LPA observed children's records to include their emergency identification information and individual infant sleeping plan. Three children’s forms did not have their guardian’s signatures on them. LPA advised licensee to have the child’s guardian sign them as soon as possible. An affidavit (LIC 282) informing parents that the facility does not carry liability insurance or a bond was not in children’s files. LPA provided licensee with an LIC 282 and advised them to have each child’s family sign an LIC 282. Licensee stated that they understood and they’re planning to acquire childcare liability insurance as well.

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.

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.

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, Yelyzaveta Demura, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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, Yelyzaveta Demura.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
LIC809 (FAS) - (06/04)
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