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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004529
Report Date: 03/07/2025
Date Signed: 03/07/2025 01:50:44 PM

Document Has Been Signed on 03/07/2025 01:50 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:BURRELL, AMINA M.FACILITY NUMBER:
414004529
ADMINISTRATOR/
DIRECTOR:		BURRELL, AMINA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 384-2609
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Amina M. BurrellTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On March 7, 2025, at approximately 8:15 a.m., Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced annual inspection, met the Assistant and the licensee, Amina M. Burrell arrived 15 minutes later. LPA explained the purpose of the inspection to the licensee.

LPA observed the licensee, assistant, eleven children were present during the inspection. (1 infant, 10 preschoolers). The licensee complies with the licensing capacity during the time of inspection today. The children’s roster had been reviewed and was found to be complete and up to date.

The licensee rents three-bedroom home and stated she and her husband are the residences of home. LPA verified with the Guardian Roster that all present/live-in adults have criminal clearance. During the visit Amina stated the home is their primary residence however they are not sleeping in this home. LPA reminded and discussed the regulations with Amina, and she will be contacted regarding the regulation shortly.
Per the licensee, the Child Care Home's operational hours are Monday through Friday, from 8:00 a.m. to 5:30 p.m.

Daycare areas: Living Room, Den, Bathroom #1, Bedroom #1, Bedroom #2, Bedroom #3, Kitchen, front yard and the backyard. Off limit areas: Garage. LPA observed all off limit areas are properly barricaded.

LPA observed the home to be clean and in good repair with proper temperature and ventilation. LPA observed several smoke detectors, carbon monoxide detector, and two fully charged fire extinguisher in the size of 2A:10BC in the kitchen and the backyard.
LPA observed the childcare home to have a functioning telephone and verified contact information. Per the licensee, there is no firearm in the home. The licensee stated that breakfast, lunch, and two snacks are provided for children in addition to drinking water. See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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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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: BURRELL, AMINA M.
FACILITY NUMBER: 414004529
VISIT DATE: 03/07/2025
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LPA and the licensee inspected the childcare areas for health and safety hazards. LPA observed the daycare area to be clean, with all outlets covered. LPA observed that all cleaning supplies and chemicals were properly stored and inaccessible to children. LPA observed that the daycare area was equipped with age-appropriate furniture, toys, books, and educational materials.

LPA observed mats/cots and individual sheets in the napping area. The licensee verified that the facility provides sheets and children bring their blankets from home. The facility currently has one infant who sleeps on mat. The licensee was informed about safe sleep regulations and LPA observed 15 minutes sleep check log was electronically maintained. The licensee acknowledged that no baby walkers, bouncers, or similar items are used during daycare hours.
LPA observed a fireplace in the living room, which was properly barricaded.

LPA inspected the children’s bathroom and observed it to be clean and sanitary, with no chemicals within the children’s reach. LPA inspected the outdoor play area for health and safety hazards and observed sufficient toys and play materials in the backyard for children. LPA observed sand for children's play and the licensee stated they cover it every night and inspect it weekly for children's health and safety.

During the inspection of the kitchen LPA observed sharp items in the drawer which was not locked. The licensee removed and placed them in a higher cabinet. Health and safety requirements were discussed with the licensee. Amina will install a child lock to the cabinets and drawers in the kitchen and provide proof to the LPA. A Technical Violation will be issued.

LPA confirmed with the licensee that an isolation area is available in the Den for ill children while waiting for their guardians to arrive. The licensee confirmed that two children currently have allergies. LPA observed the medications were not labeled and not in their original box. LPA discussed it with the licensee.

LPA reviewed nine children’s files and found that one of the children did not have an immunization record in the file. The licensee contacted the parent to send the results, and LPA reviewed the record during the inspection. LPA observed the LIC 9227 is missing in the infant's file, and this was discussed with the licensee by the LPA. A Technical Violation will be issued today.
See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
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: BURRELL, AMINA M.
FACILITY NUMBER: 414004529
VISIT DATE: 03/07/2025
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Page 3
LPA reviewed the staff file and found that the licensee and assistant have a valid Mandated Reporter certificate which expires on 12/2025. LPA observed licensee's and her assistant's CPR and First Aid certification expired in July 2023. A Type B violation will be cited on page LIC809D page.
The licensee enrolled in the course for March 15, 2025, during the inspection.

Per the licensee, emergency drills are conducted once every two months, and the latest drill was conducted on January 9, 2025.

LPA observed that all required forms and postings were displayed in the Child Care Home, including the License and Parent’s Rights Poster.

Per the licensee, the facility carries liability insurance for the daycare.

The licensee was reminded that all adults 18 years of age or older living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption as specified in Health and Safety Code Section 1596.871. This must occur prior to initial presence in a licensed Family Child Care Home. LPA informed the licensee that a civil penalty of $100 per person per day will be assessed for unqualified adults present for a maximum of five days. If this is a repeat violation, the penalty may increase to $500 per person per day after the fifth day.

LPA discussed the safe sleep regulations with the licensee and shared the Child Care Licensing Safe Sleep webpage located at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the licensee about the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov. LPA recommended that the licensee register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

See page 4.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
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: BURRELL, AMINA M.
FACILITY NUMBER: 414004529
VISIT DATE: 03/07/2025
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LPA also provided information about the MyChildCarePlan.org website, a consumer education resource that connects families with child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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/.

A Type B violation was cited on LIC809D and documented in the report. Two Technical Violation will be issued.

During the inspection, the licensee confirmed that there are no registered sex offenders living in the facility. LPA completed the RSO profile in FAS.

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

The exit interview was conducted, and the report was reviewed with the licensee, Amina M. Burrell
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2025 01:50 PM - It Cannot Be Edited


Created By: Zeynep Basak On 03/07/2025 at 01:09 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: BURRELL, AMINA M.
FACILITY NUMBER: 414004529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2025

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 observation, interview, and record review, the licensee did not comply with the section cited above in not having valid CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2025
Plan of Correction
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The licensee is already enrolled in the class for CPR certification (3/15/25). Amina will provide the certificate to the assigned LPA upon completion.
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.
SUPERVISOR'S NAME:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2025


LIC809 (FAS) - (06/04)
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