410519059-5-7-2024-05-CC-MZAA-D52V5V-20240507160835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410519059
Report Date: 05/07/2024
Date Signed: 05/07/2024 04:08:40 PM

Document Has Been Signed on 05/07/2024 04:08 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:	KERMANI-CARY, SHEILA		FACILITY NUMBER:	410519059
ADMINISTRATOR/ DIRECTOR:	KERMANI-CARY, SHEILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 742-0471
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	05/07/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:40 PM
MET WITH:	Licensee, Sheila Kermani Cary		TIME VISIT/ INSPECTION COMPLETED:	04:25 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 May 05, 2024 at approximately 1:40pm, Licensing Program Analyst Zaragoza conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee, Sheila Kermani Cary. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included Licensee’s spouse, 1 staff, and 11 children (3 infants and 8 preschool age). Hours of operation are Monday through Friday 7:30am to 5:30pm. Entrance to the facility is through side gate. Licensee lives in a one-level home with their spouse. All adults living in the home and staff present, have fingerprint clearance on file. The DAY CARE AREAS are located in the back end of the home, the playroom, classroom, bathroom #1, and backyard. The OFF LIMIT AREAS are the entire front of the home, which includes the kitchen, living room, dining room, bathroom #2, bathroom #3, bedroom #1, bedroom #2, bedroom #3, and garage. LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed electrical outlets to be made inaccessible with child safety covers. Cleaning supplies, poisons and hazardous materials are stored in home's high shelves and/or locked behind child safety locked cabinets. Home is equipped with a fully charged fire extinguisher and multiple smoke and carbon monoxide detectors. Smoke and carbon monoxide detectors were tested during visit and was observed to be in working condition. There are no pools, and bodies of water in the premises. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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: KERMANI-CARY, SHEILA	FACILITY NUMBER: 410519059
	VISIT DATE: 05/07/2024

NARRATIVE

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Napping is in the classroom. Classroom was observed to be equipped with playpens and mats for napping children. Playpens were observed to be free of loose articles, bumper pads and pillows. LPA observed playpens to have mattresses with tight fitting sheets. Sleeping logs for napping infants are maintained and includes the 15 minute time check of when infant was last checked on and sleeping position.

Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. LPA observed children’s diapers and wipes in bathroom to be properly labeled with each child’s individual names. Per licensee, children’s families provide diapers and wipes for enrolled children.

Children eat in classroom area. A food service is provided to children that includes lunch and 2 snacks. Children are welcomed to bring lunch from home if preferred. LPAs observed eating area to be clean and equipped with appropriate dining furniture. Fridge was observed to be clean with fresh food and used for storing children’s snacks.

Outdoor area is entirely enclosed and fenced. Outdoor area includes a variety of toys and equipment that were in good condition. Backyard has fake grass flooring and multiples shaded area for children when playing outdoors.

LPA reviewed 6 random children's records which were complete. LPA reviewed licensees and staff who were present records, which were complete. Licensee and staff have a current CPR/First Aid certifications and current Mandated Reporter certifications. Licensee's CPR/First Aid certification expires 12/27/24 and Mandated Reporter certifications will expire 11/2025.

Emergency disaster drills are conducted and are appropriately documented. Last disaster drill was conducted 04/09/2024. LPAs observed licensing documentation to be properly posted, made available for review. Facility maintains a childcare roster that was also made available for review. Per licensee, there are no weapons or firearms in the home.

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.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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: KERMANI-CARY, SHEILA	FACILITY NUMBER: 410519059
	VISIT DATE: 05/07/2024

NARRATIVE

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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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

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/.

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, Sheila Kermani Cary, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megans law search on 05/03/2024.

No deficiencies were issued during today'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, Sheila Kermani Cary.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

LIC809 (FAS) - (06/04)

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