013418512-12-8-2022-52-CC-JSAI-CLWUDJ-20221208142936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418512
Report Date: 12/08/2022
Date Signed: 12/08/2022 02:30:05 PM

Document Has Been Signed on 12/08/2022 02:30 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	YAROSHEVSKAYA, ANNA		FACILITY NUMBER:	013418512
ADMINISTRATOR:	YAROSHEVSKAYA, ANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 828-3071
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	12	CENSUS: 8	DATE:	12/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Licensee, Anna Yaroshevskaya		TIME COMPLETED:	02:50 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, Anna Yarosherskaya for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee, her mother supervising one infant and 7 preschoolers. Licensee is within capacity limits of a Large License Licensee lives in the home with her husband. The home is a two-story home with 4 bedrooms and 2 bathrooms on the second floor; The first floor consist of the family room, which is used as the main day-care area, half bathroom, living room, kitchen, dining room, garage and back yard. The hours of operation are 7:00AM- 6:00PM, Monday -Friday.

ON-LIMIT AREAS : family room and half bathroom, backyard.
OFF-LIMIT AREAS are the entire second floor, kitchen, dining room, living room and garage, and are made inaccessible to children by locked doors, safety gates and visual supervision.

LPA observed the following: Daycare Area is clean, orderly, and equipped with age appropriate toys and equipment for children, indoors and outdoors. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water or Fireplace in the Daycare area. There are child size tables and chairs for snack and activities. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. The napping room had cots in good condition and each child have their separate blankets. The blankets are washed weekly by the Parents. There is a child safety gate located at the bottom of the stairs to prevent access to the stairs and upper levels to children in care. The outdoor area has age appropriate toys and furnishings and free from defects and dangerous conditions. Licensee states there are no guns or weapons of any kind in the home. The facility has a pet dog.

Licensee and helper’s CPR expire in 03/2024. Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children’s files. All the files are complete and up to date. The licensee was reminded about infant's sleep checks. All required postings are properly posted.

see next page...

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: YAROSHEVSKAYA, ANNA	FACILITY NUMBER: 013418512
	VISIT DATE: 12/08/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During Inspection, 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.

Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

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/inspection-process.

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

Exit interview conducted and report was reviewed with the licensee, Anna Yaroshevskaya.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2