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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700158
Report Date: 08/28/2020
Date Signed: 08/28/2020 12:00:48 PM

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:ZAYMAK, DINAFACILITY NUMBER:
015700158
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/28/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:DINA ZAYMAKTIME COMPLETED:
11:58 AM
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DUE TO THE COVID-19 PANDEMIC, THIS PRE-LICENSE VISIT WAS DONE VIRTUALLY / TELE-VISIT VIA ZOOM MEETING.

On August 28, 2020, at approximately 9:00am Licensing Program Analyst (LPA) Russ Haderer met with (applicant) Dina Zaymak (VIA ZOOM MEETING) for the purpose of conducting an announced pre-licensing inspection for Health and Safety compliance. Applicant owns the townhouse and lives there with her fingerprint cleared and TB tested husband and their 10 year old (almost 11) daughter. Applicant, her husband and daughter were in the home today. The hours of operation will be Monday-Friday, 8:00AM to 1:00PM.

The facility is a 2 bedroom, one and 1/2 bath two-story townhouse with no garage. It is owned by the applicant and contains a living room, dining room, kitchen, 2 bedrooms and one and 1/2 bathrooms, two enclosed (fenced) outside patio areas. The home is neat and clean with heating and ventilation for safety and comfort. Per the applicant, the ISOLATION AREA will be in the kitchen area and away from the other children in care.

On-limit areas include: First floor area consisting of the living room (day care area), kitchen, dining room, downstairs half-bath and patio area off the living room. Applicant was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit areas include: The closet in the living room (has a slide-bolt latch mounted high and out of reach of children), the patio off the kitchen/dining room area (has lockable sliding glass door), the entire upstairs consisting of 2 bedrooms, full bathroom and laundry area. The stairs have a gate preventing children from accessing the off-limit area upstairs and other off limit areas will be inaccessible by closed and/or locked doors, and/or by child supervision.


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SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
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 3
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: ZAYMAK, DINA
FACILITY NUMBER: 015700158
VISIT DATE: 08/28/2020
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LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. There is a children’s play area in the common area of the condominium complex with soft ground cover materials and safe and solid structures. Applicant has a first aid kit and plastic outlet covers on all electrical outlets in the on-limit areas.

Applicant has ample age-appropriate toys and learning materials. The home has a fully charged 2A10BC fire extinguisher, two working smoke and carbon monoxide detectors (tested and functioning), and a working telephone. The applicant’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 08/22/2022. The applicant completed and received a certificate in mandated reporter training (verified AB1207), expires on 11/23/2021. The applicant is in compliance with the immunization laws which pertains to day care providers.

LPA reminded the applicant of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports. There is no fireplace in the home and per applicant, there are no firearms in the home. Ratios were discussed and a copy left for applicant as a reminder.



Applicant 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. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ZAYMAK, DINA
FACILITY NUMBER: 015700158
VISIT DATE: 08/28/2020
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The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

LPA Haderer mailed a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

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

This home is provisionally licensed on 08/28/2020. Once the items listed below are in place, and an inspection has been done to confirm it, a full regular license will be issued. This report shall remain on file for 3 years.

Items needed for full licensure issue:

Safety latches on lower kitchen cabinet doors and cabinet drawers within reach of children.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3