013423402-5-8-2019-52-CC-SKAR-BBYMVU-20190508095720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423402
Report Date: 05/08/2019
Date Signed: 05/08/2019 09:57:24 AM

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:	LOKTEVA, OXANA		FACILITY NUMBER:	013423402
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	05/08/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Oxana Lokteva		TIME COMPLETED:	10:15 AM

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) Simerjit Kaur arrived to the facility unannounced to conduct a Case Management Inspection for an INCREASE IN CAPACITY. LPA met Licensee Oxana Lokteva to conduct inspection. Present during today's visit was the 6 preschool age children. This facility currently operates from 8:00am until 6:30pm Monday through Friday. The home is a single story home consisting of 3 bedrooms, 2 bathrooms, kitchen, day care room, dining room, backyard and garage. The ON LIMITS areas are: the day care room, dining area, bathroom located at the end of hallway, master bedroom located right side of the hallway, and backyard area. The OFF LIMITS areas are: 2 bedrooms located on right side of hallway, 1 bathroom located in the master bedroom, the garage, left side of the backyard and the kitchen. Per the fire clearance, all exits are to remain free and clear of obstructions, licensee must exercise monthly emergency evacuation drills, there must be 2 adult care providers on site during operational hours. The home is clean during today's inspection. The Licensee has a current children's roster and copy obtained. The home has a fully charged fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and a pull down fire alarm. The licensee CPR and First Aid certificate is current and expires 02/03/20 and she received a certificate in mandated reporter training on 12/11/17. The fireplace is screened to prevent access by children. Outdoor play area is fenced and supervised by the Licensee. The fire clearance for the increase in capacity was received and approved on 04/22/19. LPA Kaur provided a copy of Safe Sleep Regulation Concept and discussed licensing forms with licensee. See 809-C

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 292-7241
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LOKTEVA, OXANA	FACILITY NUMBER: 013423402
	VISIT DATE: 05/08/2019

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LPA informed licensee of Assembly Bill 1207, the mandated reporter training which can be found at www.mandatedreporterca.com.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

No deficiencies are being cited. This home is recommended for the capacity increase as of today's date. This report shall remain on file for 3 years. Exit interview conducted with licensee. Notice of Site Visit provided and must be posted for 30 days.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 292-7241
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

LIC809 (FAS) - (06/04)

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