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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004073
Report Date: 02/17/2022
Date Signed: 02/17/2022 12:47:16 PM

Document Has Been Signed on 02/17/2022 12:47 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BURYN, KAREN M.FACILITY NUMBER:
384004073
ADMINISTRATOR:BURYN, KAREN M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 213-7250
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karen BurynTIME COMPLETED:
12:45 PM
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On February 17, 2022, Licensing Program Analyst (LPA), Van, conducted an unannounced required annual inspection and met with Karen Buryn. The purpose of the inspection was explained and granted entry to the home by the Licensee. There are six children in care with Licensee today (one infant and five preschoolers). All Adult residents have the fingerprint clearance on file. Days and Hours of operation are M -F, 8 am- 6 pm. Daycare areas are the Living Room, Half side of the Kitchen, Bathroom #1, and the main Backyard. OFF limit areas are Bedroom #1, Bedroom #2, Loft/Office, Bathroom #2, Garage, Furnace Room, the other half side of the Kitchen, small deck, and small room/shed at the very end of the backyard. All off-limit areas, including closets, are adequately barricaded. Per Licensee, when a child shows signs of illness, the Licensee will separate and have the child waiting in the living while contacting the parent to pick up, and the healthy children will be transitioned to the dining area.

LPA and Licensee inspected the daycare areas for health and safety hazards during the inspection. LPA observed the following: The daycare area is clean, orderly, and equipped with safe, age-appropriate toys and equipment. LPA observed each child has individual storage space for their belongings. The home has adequate lighting ventilation and is free from defects or conditions that endanger children in care. The daycare has multiple combination smoke alarms & carbon monoxide detectors and fully charged fire extinguishers. First aid supplies are available for children. Poisons, detergents, cleaning compounds are inaccessible to children. The backyard is observed to be fenced, clean, and has age-appropriate toys and outdoor equipment are in good condition. Soft cushions are installed underneath the play structures to absorb children's falls. The licensee states there are firearms in the home, ammunition, and firearms are stored in the off-limit area and locked separately. The Licensee has a pet dog; the Licensee states that the dog's vaccinations are all current. LPA observed the Licensee had posted all the required forms, such as facility License, Notification of Parent's Rights, Earthquake Preparedness checklist, and Notification of Personal Rights.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BURYN, KAREN M.
FACILITY NUMBER: 384004073
VISIT DATE: 02/17/2022
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The Licensee states she provides breakfast, lunch, morning and afternoon snacks to children. LPA observed no pools, spas, or other bodies of water on the premises. Licensee states Fire and Earthquake drills are conducted every six months, and the last drill was conducted on 12/6/21. During the inspection, LPA reviewed records of all six children present. LPA observed each child has a complete emergency information card with the child's full name, telephone number, and location of a parent or other responsible adult to be contacted in an emergency. The name and telephone number of the child's physician and the parent's authorization for the Licensee or registrant to consent to emergency medical care. Licensee has a record of immunization and valid Pediatric FirstAid & CPR (CPR is valid until 12/5/2022)

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 the Licensee and discussed the Child Care Licensing Safe Sleep webpage 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.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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 can be obtained online at www.mandatedreporterca.com.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BURYN, KAREN M.
FACILITY NUMBER: 384004073
VISIT DATE: 02/17/2022
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LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at [email protected] and ask to be added to the email list for the updates.

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 [email protected]. 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.

The report was reviewed and signed by the Licensee, Karen Buryn. No deficiencies were observed in today's inspection. Today's report, 2/17/2022, and notice of site visit will be sent to the Licensee email by the close of business on 2/17/2022. Confirmation of receipt is required, and a notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC809 (FAS) - (06/04)
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