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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410519059
Report Date: 03/07/2023
Date Signed: 03/07/2023 01:16:13 PM

Document Has Been Signed on 03/07/2023 01:16 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 CHILD CARE, 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: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 11DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sheila Kermani-CaryTIME COMPLETED:
01:20 PM
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On March 7, 2023 at approximately 10:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Sheila Kermani-Cary, and explained the purpose of the inspection. Present during LPA's visit included licensee, licensee's aide, and 11 enrolled children (1 infant and 10 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have fingerprint clearance on file.

LPA inspected the day care areas for health and safety hazards. Licensee lives in the single level home with their spouse. Entrance to the day care is through side gate located on right side of home. The DAY CARE AREAS are the main classroom (back of the home), bathroom #3 (in main classroom), and side/back yard. The OFF LIMIT AREAS includes the garage and entire rest of the home. Off limit areas are made inaccessible with closed, locked doors.

LPA observed home to be in good repair with proper temperature and ventilation. Licensee operates home as a Montessori program. Home is equipped with a variety of toys and materials that were in good condition. LPA observed a variety of Montessori materials that were age appropriate. LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers. Main classroom includes a fireplace that is properly barricaded and made inaccessible to children. There is sufficient storage space for children's personal belongings.

Entire outdoor area is enclosed with an at least 5 ft. high fence. There were no pools, spas or bodies of water on the property. Backyard is equipped with appropriate outdoor toys and equipment that are in good working condition. Flooring in backyard is padded with artificial turf and carpeting. Cleaning supplies, poisons and other chemicals were stored inaccessible to children behind child safety locked cabinets.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KERMANI-CARY, SHEILA
FACILITY NUMBER: 410519059
VISIT DATE: 03/07/2023
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Home is equipped with a working carbon monoxide detector, smoke detector, fire extinguisher and working telephone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home. There are two cats in the home that are maintained separate from enrolled children, located in off limit areas.

LPA reviewed 5 children's records, whom were present during the inspection, which were complete. Children's files have a record of emergency identification information on file. LPA reviewed licensee and aide's files, which were also complete. Both licensee and aide have record of required immunizations that were made available for review. Both licensee and aide have current CPR certifications that will expire 12/2024 and current Mandated Reporter certifications.

Emergency drills are conducted at least once every six months and are properly logged. Last emergency disaster drill was conducted 02/13/2023.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KERMANI-CARY, SHEILA
FACILITY NUMBER: 410519059
VISIT DATE: 03/07/2023
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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-and-resources/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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

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.

Exit interview conducted and report was reviewed with the licensee, Sheila Kermani-Cary.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
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