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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004300
Report Date: 11/06/2025
Date Signed: 11/06/2025 05:06:29 PM

Document Has Been Signed on 11/06/2025 05:06 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:ABDULLAH, SAIMA B.FACILITY NUMBER:
414004300
ADMINISTRATOR/
DIRECTOR:		ABDULLAH, SAIMA B.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 267-0065
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
11/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH: Saima AbdullahTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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On 11/6/2025, at approximately 10:15AM Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA Alvarado met with Licensee Saima Abdullah (L1) and disclosed the purpose of the visit for today. LPA Alvarado observed Present in the Facility is (L1) and Assistant supervising 11 children (3 infants and 8 preschoolers). The licensee is a large license and is operating within capacity limits and ratio during today’s inspection. (L1) was reminded that if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in 102416.5 Staffing Ratio and Capacity. At 11:00am a second assistant arrived to the facility. Facility has a pet cat, that does not come in contact with children in care and is located in an off limit part of the home.

The following areas are used for Family Child Care: Part of the lower level of the Home, which includes the Bedroom, Bathroom, Family Room, and Kitchen. Outdoor Play Yard.

The Off-Limit Areas are: The entire second floor, Living Room (Only for Napping), Garage and Front Yard.

LPA inspected the home indoors and outdoors for any health or safety hazards along with (L1). The home is clean and in orderly condition. The home is equipped with a fully charged fire extinguisher. Facility has a carbon monoxide detector that was observed functioning during today’s inspection. LPA also observed at least one functioning smoke alarm during today’s inspection. Facility has a fireplace that is gas located in the family room which was observed to be properly barricaded with a children’s bookshelf. Off limit spaces, and drawers were observed to be locked, barricaded and made inaccessible to children in care.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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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: ABDULLAH, SAIMA B.
FACILITY NUMBER: 414004300
VISIT DATE: 11/06/2025
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During today’s inspection LPA observed children in the living room during activity time. (L1) guided LPA to the second floor where one infant was observed to be napping. LPA reminded (L1) that the second floor has not been approved by the department. (L1) removed the infant and placed in the lower level of the home in approved space. LPA reminded the licensee that any off-limit areas must be approved by the department prior to use. LPA suggested that (L1) submit a new application to the Department along with updated documentation to license the living room that is currently off limits and only approved for nap use. LPA also reminded (L1) that the stairs in the living room leading to the second floor must be barricaded. (L1) was reminded that any off-limit areas must be approved by the department prior to use. As of now the living room may not be used until the department has approved it. (L1) has a baby gate between the kitchen and living room.

Outdoor play yard was observed to be free of debris, plenty of outdoor toys for children, little playhouses, climbing equipment. LPA observed soft landing material under high climbing equipment to absorb falls.

Facility hours are Monday-Friday 7:30AM-5:30PM. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Per (L1) Facility provides Breakfast, Lunch and Snack. (L1) stated that families also can provide children meals if they would like. Facility provides napping equipment such as pack n plays, cots and cushioned mats. (L1) stated that communication is through Brightwheel, Text messages and verbal communication in person. Per (L1) there are no firearms present in the facility. All chemicals and Poisons are locked and made inaccessible to children. Facility has a fully equipped First Aid Kit. Phone number listed on file for Licensee is current.

No pools, hot tubs, spas, fishponds or similar bodies of water observed on the property. Licensee also confirmed no bodies of water on property. License was reminded that Babywalkers, bouncers, jumpers and similar items will not be used for children in care and are not allowed.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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: ABDULLAH, SAIMA B.
FACILITY NUMBER: 414004300
VISIT DATE: 11/06/2025
NARRATIVE
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During Record Review, (L1) assistants do not have Pediatric First Aid/CPR. (L1) and Assistants did not have completed Mandated Reporter Training. (L1) was reminded that CPR/First Aid and Mandated Reporter Training needs to be renewed every two years for the licensee and all assistants present who are providing care and supervision. During record review it was also observed that staff did not have complete Personnel Records. LPA provided (L1) the Entrance Checklist (LIC126). LPA reviewed twelve children records, which were observed to be complete, and facility records. Required postings were observed to be posted, LPA reminded (L1) of a few that were missing.

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.

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 at https://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.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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: ABDULLAH, SAIMA B.
FACILITY NUMBER: 414004300
VISIT DATE: 11/06/2025
NARRATIVE
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Licensee was provided by LPA Alvarado a packet containing the Recently Approved Safe Sleep Regulations in Effect PIN 20-24-CCP, along with a Copy of the Infant Sleep Chart for Documentation of the Infant 15-Minute check, a copy of the Infant Sleeping Plan (LIC 9227), CDSS additional information regarding Safe Sleep in Child Care information and a Copy of the Child Care Centers Regulations that include 101239. Fixtures, Furniture, Equipment and Supplies, 101416.5. Staff-Infant Ratio, 101419.2. Infant Needs and Services Plan, 101429. Responsibility for Providing Care and Supervision for Infants, 101430 Infant Care Activities, and 101439.1. Infant Care Center Sleeping 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, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC 809-D for deficiencies being cited today on 11/6/2025 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Care and Supervision, Facility Administration and Records.

See LIC 9102-TV for Technical Violation regarding Physical Plant and Facility Administration.
See LIC9102-TA for Technical Advisory regarding Physical Plant and Records.

Appeal rights were provided to Saima Abdullah. 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 was conducted with Licensee, Saima Abdullah.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Diana Alvarado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/06/2025 05:06 PM - It Cannot Be Edited


Created By: Diana Alvarado On 11/06/2025 at 03:41 PM
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: ABDULLAH, SAIMA B.
FACILITY NUMBER: 414004300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in three out of three persons, Licensee has three infants that are under 24Months, and Licensee has been only maintaining 15-Min sleep check for one of the three infants which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2025
Plan of Correction
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Licensee will continue to conduct and document 15-Min sleep checks for all infants 24Months and under. Licensee will submit via email to LPA Alvarado of Maintained 15-Min Sleep checks by 11/28/2025. LPA Alvarado will also conduct a follow up inspection with the facility.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in three out of three persons have not completed the Mandated Reporter Training for the Licensee and Two Assistants which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2025
Plan of Correction
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Licensee and both Assistants will take and complete the Mandated Reporter Training and will submit to LPA Alvarado via email by 11/28/2025 the completed Mandated Reporter Training Certificates. LPA Alvarado will also conduct a follow up inspection with the facility to ensure that they are being maintained.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Diana Alvarado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
Page: 6 of 13
Document Has Been Signed on 11/06/2025 05:06 PM - It Cannot Be Edited


Created By: Diana Alvarado On 11/06/2025 at 03:41 PM
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: ABDULLAH, SAIMA B.
FACILITY NUMBER: 414004300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025

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 interview and record review, the licensee did not comply with the section cited above in two out of two persons, LPA observed that the two assistants for the Licensee do not have Pediatric First Aid/CPR which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2025
Plan of Correction
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Licensee and both Assistants will submit proof of enrollment to LPA Alvarado via email by 11/28/2025 of the enrollment of Pediatric CPR and First Aid issued by the American Red Cross or the American Heart Association or by the approved Emergency Medical Services (EMSA) vendor. Licensee and assistants will also complete Pediatric CPR and First Aid and submit the verification to LPA Alvarado Via email. LPA Alvarado will also conduct a follow up inspection to ensure that documentation is being maintained.
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in two out of two assistants did not have personnel records available for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2025
Plan of Correction
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LPA provided the Licensee with the Entrance Checklist (LIC 126) and letting the Licensee know of all the forms and documentation that need to be in the file for each assistant, for Personnel Records. Licensee will submit via email to LPA Alvarado proof of all the documentation that is required for each assistant’s personnel records. LPA Alvarado will also conduct a follow-up inspection with the facility to ensure that documents are being maintained.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Diana Alvarado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


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Document Has Been Signed on 11/06/2025 05:06 PM - It Cannot Be Edited


Created By: Diana Alvarado On 11/06/2025 at 03:41 PM
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: ABDULLAH, SAIMA B.
FACILITY NUMBER: 414004300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in two out of two assistants who did not have immunizations available for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2025
Plan of Correction
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Licensee will submit proof of both assistant Immunizations to LPA Alvarado by 11/28/2025 of measles, pertussis and Influenza (or documentation of exemption).
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.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Diana Alvarado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
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