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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002194
Report Date: 06/10/2026
Date Signed: 06/10/2026 11:35:17 AM

Document Has Been Signed on 06/10/2026 11:35 AM - 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:TSYURA, IRINAFACILITY NUMBER:
414002194
ADMINISTRATOR/
DIRECTOR:
TSYURA, IRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 722-5458
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 12DATE:
06/10/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Irina TsyuraTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On June 10, 2026, Licensing Program Analyst (LPA) Van conducted an announced annual inspection and met with the Licensee, Irina Tsyura. The purpose of the inspection was explained, and access to the home was granted. Upon entry, LPA observed the Licensee and two assistants supervising 11 children (10 preschool-aged and 1 school-aged), as they prepared for breakfast. During the visit, one additional preschool-aged child arrived. All adults living or working in the home have criminal record clearances. The facility operates Monday through Friday from 7:30 a.m. to 6:00 p.m.

According to the Licensee, she currently has 17 children enrolled. She stated that not all 17 children attend at the same time, as some attend part-time and a few are school-aged children who arrive only during recess.

Along with the licensee, LPA toured and inspected the home for potential health and safety hazards. The childcare areas are the living room (playroom), dining room (classroom), lobby area, bathroom #1 located in the lobby on the ground floor, and the backyard. The off-limit areas are the kitchen, garage, and the entire third level of the home. Flooring in the day-care areas consisted of clean, stain-free carpets and rugs. LPA did not observe any accessible electrical outlets or cleaning solutions. Sufficient storage for children’s belongings was in the lobby, with cubbies labeled with children’s names and photos. All day-care areas were clean, organized, and equipped with appropriate toys and materials.

During the walkthrough, LPA observed that the kitchen was accessible to children as they passed through the dining room area. LPA also observed a knife on the kitchen counter that was potentially accessible to children. LPA advised the Licensee to ensure the kitchen remains fully inaccessible at all times. LPA recommended keeping the door between the dining room and kitchen locked and installing a baby gate between the hallway and kitchen. Children will still be able to access the lobby and backyard without entering the kitchen once these barriers are in place. The licensee agreed and stated that she will purchase and install the baby gate. Pictures will be sent to LPA.


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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2026
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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Document Has Been Signed on 06/10/2026 11:35 AM - It Cannot Be Edited


Created By: Brendon Van On 06/10/2026 at 10:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TSYURA, IRINA

FACILITY NUMBER: 414002194

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and a review of records, the Licensee did not comply with the above cited regulation. The Licensee and two assistants did not have valid Pediatric First Aid/CPR certifications. This does not meet the regulatory requirement for ensuring that trained staff are available to respond to medical emergencies, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2026
Plan of Correction
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The Licensee agrees to ensure that all required staff obtain current Pediatric First Aid/CPR certification from an approved training provider. Proof of completed certification for the Licensee and both assistants will be submitted to the Department by the due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Brendon Van
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2026


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: TSYURA, IRINA
FACILITY NUMBER: 414002194
VISIT DATE: 06/10/2026
NARRATIVE
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The Licensee stated that her program serves only preschool-aged and school-aged children. She also stated that she understands safe sleep requirements for infants, including the need for tightly fitted crib sheets, cribs free of toys, blankets, and pillows, and the requirement to conduct and document 15-minute checks if infants are ever in care.

Safety equipment and environmental conditions were reviewed. The home has multiple smoke alarms and a carbon monoxide detector; all were tested during the inspection and were found functioning. The fireplace was observed completely covered with drywall. A complete first aid kit was readily available. According to the Licensee, there are no guns or weapons present in the home. The facility has no bodies of water. Cleaning products and disinfectants were stored in off-limit areas inaccessible to children. A functional telephone was present. The facility also had multiple fully charged fire extinguishers with a minimum rating of 2A:10BC. The Licensee acknowledged that baby walkers, bouncers, exersaucers, and similar items are not permitted during daycare hours.

LPA reviewed staff training and children’s records. All three staff members present had expired Pediatric First Aid/CPR certifications: two expired in February 2025, and one expired in April 2026. The Licensee and her assistants have valid Mandated Reporter Training certificates and complete immunization records. The last fire and earthquake drills were completed on 12/27/2025 and were properly documented.

Children’s files were reviewed and found to contain all required forms, including vaccination records, Parental Rights forms, and complete emergency information cards. The children’s roster was current. No transportation is provided. Capacity requirements were reviewed, and the Licensee acknowledged understanding of the limits specified on the license. Reporting requirements for suspected child abuse and unusual incidents were discussed. All required postings were observed, including the facility license, the Parents’ Rights poster, the Emergency Disaster Plan, and the Earthquake Preparedness Checklist.

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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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
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: TSYURA, IRINA
FACILITY NUMBER: 414002194
VISIT DATE: 06/10/2026
NARRATIVE
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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.

LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep web page https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.

Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training is available online at www.mandatedreporterca.com.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

During the exit interview, the LICENSEE, IRINA TSYURA, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

See LIC 809D for the deficiency cited today.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, the report and appeal rights were reviewed with the licensee, Irina Tsyura.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC809 (FAS) - (06/04)
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