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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004675
Report Date: 05/27/2026
Date Signed: 05/27/2026 11:24:04 AM

Document Has Been Signed on 05/27/2026 11:24 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:GOOMER, SEEMAFACILITY NUMBER:
414004675
ADMINISTRATOR/
DIRECTOR:		GOOMER, SEEMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 627-7206
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 12DATE:
05/27/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:Seema GoomerTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On May 27, 2026, Licensing Program Analysts (LPAs) Leong and Van arrived at the facility to conduct an unannounced Plan of Correction (POC) visit. LPAs met with Licensee Seema Goomer and explained the purpose of the visit.

The licensee and her assistant were observed caring for one infant and eleven preschool-aged children.

On March 12, 2026, the following swimming pool safety requirements for a Family Child Care Home (FCCH) were not observed to be met under HSC 1596.814:

· An access gate that opens away from the pool, is self-closing, and has a self-latching, key-lockable device placed no lower than 60 inches from the ground.

· A maximum vertical clearance of two inches from the ground to the bottom of the enclosure.

· A rescue pole with a body hook and a minimum fixed length of 12 feet.

· A daily inspection of drowning-prevention safety features and equipment, with a log maintained and available to the Department upon request.

During today’s visit, LPAs observed the following items, which were found to meet FCCH swimming pool safety requirements:

· A self-closing gate with a key attachment.

· Ground-to-bottom enclosure clearance measured at less than two inches.

· A 15-foot rescue pole with a body hook.

· A daily inspection log for the swimming pool.

See Page 2

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2026
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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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: GOOMER, SEEMA
FACILITY NUMBER: 414004675
VISIT DATE: 05/27/2026
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Page 2
The licensee presented receipts for the mesh fencing and pool cover. According to the manufacturer’s website, both the mesh fencing and the pool cover are certified by the American Society for Testing and Materials (ASTM), consistent with ASTM certification standards.

LPA Leong will mark the swimming pool deficiency from March 26, 2026, as corrected during today’s visit.

LPAs instructed the licensee that only the concrete area of the backyard may be used by children at this time. The approved area begins at the stairs and extends to the children’s playhouse.

The following conditions must be met before children may use any area beyond the playhouse:

- The side pathway of the backyard must be fully barricaded.

- All debris and hazardous items must be removed from the grass area.

The licensee must send a video to LPA Leong demonstrating that the backyard is cleared of debris and hazardous items and that the side pathway of the backyard is barricaded.

The licensee stated she will contact the manufacturer to obtain written documentation confirming that the mesh fencing and pool cover are ASTM certified.

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

Exit interview conducted and report was reviewed with the licensee, Seema Goomer.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026
LIC809 (FAS) - (06/04)
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