410519059-4-24-2025-05-CC-RWAA-DG2VVG-20250424164620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410519059
Report Date: 04/24/2025
Date Signed: 04/24/2025 04:47:07 PM

Document Has Been Signed on 04/24/2025 04:47 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: 13	CENSUS: 10	DATE:	04/24/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Sheila Kermani-Cary		TIME VISIT/ INSPECTION COMPLETED:	05:00 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 4/24/2025, at approximately 2:00 PM, Licensing Program Analysts (LPAs) Wadhwa and Van, conducted an unannounced, annual inspection. LPAs met with Licensee, Sheila Kermani Cary, and explained the purpose of the visit. Present during the visit was licensee, one helper (H1) and 9 preschoolers and 1 infant in care. The facility is in compliance with staffing and ratio requirements on this day. Licensee lives in the home with her spouse. Licensee’s daughter visits every other weekend and lives in the home during summer. All adults present today have fingerprint clearance on file. Licensee’s daughter is in process of getting her fingerprint clearance. Hours of operation are Monday through Friday 7:30am to 5:30pm. The Day Care Areas are the back end of the home which includes the playroom, a classroom, bathroom#1 and the 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. LPAs toured the facility with licensee, to conduct a health and safety inspection. The facility is equipped with age-appropriate furniture, toys, and equipment. All poison, cleaning supplies and other chemicals are inaccessible to children and stored in the front part of the home. Cabinets and drawers are made inaccessible to children with multiple child safety locks. Home is equipped with multiple smoke and carbon monoxide detectors, and a fully charged 2A10-BC fire-extinguisher. LPAs tested one of the smoke and carbon monoxide detectors and found it to be in working condition. The backyard used as outdoor play area is fully fenced and enclosed and includes a variety of toys and equipment that were in good condition. LPAs did not observe any pools, spas, or bodies of water on site. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

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: KERMANI-CARY, SHEILA	FACILITY NUMBER: 410519059
	VISIT DATE: 04/24/2025

NARRATIVE

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Children nap in the classroom. The facility is equipped with playpens and mats for children. LPAs observed that one preschool child using a pack and play for napping while other children slept on floor mats. Blankets are provided from children’s homes. Per licensee, bedding is sent home to be laundered once a week. LPAs observed Licensee maintains a sleep log for infants in care however found them to not have the 15-minute physical check documented. LPAs advised that sleeping logs be maintained in adherence to licensing requirements, for all children under 24 months of age. A technical violation was issued.

Licensee uses a cell phone for communicating with the parents. Phone number for licensee is current. Per Licensee, there no weapons or firearms in the home. The facility conducts a fire and disaster drill every month. The last drill was conducted on 4/10/2025. LPAs observed licensing documentation to be posted and made available for review, including the Facility License; Notice of Parents Rights (PUB393); Emergency Disaster Plan (LIC610); and Updated Menu and the home’s Liability Insurance.

Per licensee, the facility provides a food service including two snacks and one hot lunch. Water is provided from home in individual cups and refilled as needed. The licensee posts the food menu in classroom and provides a copy to the parents, in advance, each month.

LPAs reviewed all children’s files and facility records. Children's files have a record of emergency identification information as well as required immunizations. The licensee and helper have a current CPR/First Aid training certificate and Mandated Reporter Training certificate. Helper was missing a required immunization (MMR) on record. As a result, a technical violation was issued. LPAs advised licensee to maintain immunizations records and a current flu vaccine on file or documentation declining the vaccine.

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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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025

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: KERMANI-CARY, SHEILA	FACILITY NUMBER: 410519059
	VISIT DATE: 04/24/2025

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.

LPAs 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. LPAs 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are 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, licensee Sheila Kermani – Cary, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the Licensee, Sheila Kermani-Cary.
Due to printing difficulties, a copy of today's report and the notice of site visit will be mailed out to the licensee. The notice of site visit must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025

LIC809 (FAS) - (06/04)

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