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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002194
Report Date: 05/03/2023
Date Signed: 05/03/2023 10:47:47 AM

Document Has Been Signed on 05/03/2023 10:47 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:TSYURA, IRINAFACILITY NUMBER:
414002194
ADMINISTRATOR:TSYURA, IRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 722-5458
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Irina TsyuraTIME COMPLETED:
11:00 AM
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On May 3, 2023 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee's assistant, A1, and explained the purpose of the inspection. Per A1, licensee went to complete an errand.

Hours of operation are Monday through Friday 7:30am to 6:00pm. Main entrance to day care is through side gate, located on left side of home. At approximately 8:50am, Licensee arrived to facility. LPA met with licensee, Irina Tsyura, and continued inspection with licensee. Present during LPA's visit included licensee, licensee's two assistants (A1&A2), and 7 children (2 infants and 5 preschool age). Facility 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.

Licensee owns the multi-level home. The DAY CARE AREAS are the living room (play room), dining room (classroom), kitchen (pass by only), lobby area, bathroom #1 (located in lobby area on ground floor) and backyard. The OFF LIMIT AREAS are the garage and entire third level of home. Off limit areas are made inaccessible with child safety gates and/or locked doors.

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 equipment that were in good working condition. LPA observed cleaning supplies, poisons and other chemicals to be stored inaccessible in home's high shelves. There is sufficient storage space for children's belongings, located in lobby area. Living room includes a fire place that has been covered and made inaccessible to children. LPA observed electrical outlets to be properly barricaded with child safety covers.

Bathroom for children's use was observed to be clean. Bathroom is equipped with appropriate toileting equipment and appropriate sanitation products, labeled with each child's individual names.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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: TSYURA, IRINA
FACILITY NUMBER: 414002194
VISIT DATE: 05/03/2023
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Home is equipped with a first aid kit, multiple fire extinguishers, and multiple working smoke and carbon monoxide detectors. Per licensee, there are no weapons or firearms in the home.

Entire backyard is enclosed with an at least 5 ft. high fence. Flooring in backyard is cushioned with resilient padding. LPA observed backyard to be equipped with appropriate outdoor materials that were in good working condition.

LPA reviewed 7 children’s records which were complete. Children’s files have a record of emergency identification information on file. LPA reviewed licensee, A1 and A2's files which were also complete. All assistants present have both a current CPR/First Aid certification and Mandated Reporter certification. Licensee's CPR/First Aid certification is current and will expire 02/2025. Licensee's Mandated Reporter certification is current and will expire 04/2025. Both licensee and assistants present have required immunizations that were made available for review during LPA's visit.

Last emergency drill was conducted 12/17/2022. Emergency drills are conducted at least once every six months and are properly logged. Licensee has all required licensing documents properly posted and available for review.

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

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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: TSYURA, IRINA
FACILITY NUMBER: 414002194
VISIT DATE: 05/03/2023
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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.

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 maintain posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Irina Tsyura.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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