015700158-3-2-2022-52-CC-RHAR-CC5SXH-20220302131557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700158
Report Date: 03/02/2022
Date Signed: 03/02/2022 01:16:06 PM

Document Has Been Signed on 03/02/2022 01:16 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:	ZAYMAK, DINA		FACILITY NUMBER:	015700158
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	03/02/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Dina Zaymak		TIME COMPLETED:	01:25 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	On March 2, 2022 at approximately 11:10am Licensing Program Analyst (LPA) Haderer arrived for an unannounced case management visit for a capacity change inspection. Present in the home today was licensee Dina Zaymak, her fingerprint cleared and TB tested assistant Anna Antonova and 6 children in care (three 2-year old; one 3-year old; one 4-year old; one 5-year old). Hours of operation remain the same at 8:30am to 5:15pm. All requested documents were received for the increase of capacity application. The fire clearance for a capacity of 14 was received from the Fremont Fire Department on 02/23/2022. The Licensee was reminded to abide by the conditions of the fire clearance (second floor off limits to children). Pull down alarm has been installed in the living room near the front door. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home. A copy of the approved children ratios was printed and given to licensee. The facility is a 2 bedroom, one and 1/2 bath two-story townhouse with no garage. It is owned by the licensee and contains a living room, dining room, kitchen, 2 bedrooms and one and 1/2 bathrooms and two enclosed (fenced) outside patio areas. There is no fireplace in the home. The home is neat and clean with heating and ventilation for safety and comfort. The Per the licensee, the ISOLATION AREA will be in the kitchen area and away from the other children in care. Licensee has ample age-appropriate toys and learning materials. The home is a was toured and inspected for health and safety. Disaster drills are conducted every six months, the last one was done February 24, 2022. Per licensee, there are no firearms in the home. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZAYMAK, DINA	FACILITY NUMBER: 015700158
	VISIT DATE: 03/02/2022

NARRATIVE

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The home has a fully charged 2A10BC fire extinguisher mounted in the kitchen, working smoke detectors and carbon monoxide detector (tested and working), and working telephone.

The home on-limits and Off-limits will remain as previously licensed.
On-limit areas include: First floor area consisting of the living room (day care area), kitchen, dining room, downstairs half-bath and both patio areas off the kitchen and living room. Licensee 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) such as 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 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.

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. Licensee has a first aid kit and plastic outlet covers on all electrical outlets in the on-limit areas.

Children’s files were reviewed and were complete. Licensee does not carry liability insurance, appropriate signed forms are in all the children's files.

The licensee’s and assistant’s CPR and First Aid certificate are current and expire (licensee: 8-23-2022; assistant 8-18-2023). The licensee completed and received a certificate in mandated reporter training (verified AB1207) on 12-14-2021. The assistant's Mandated Reporter certificate has expired, assistant will renew certificate. Licensee is in compliance with the immunization laws which pertains to day care providers. Assistant's MMR, tdap and flu shot records were not in the file. Licensee to provide these records to LPA. Licensee’s family is in compliance with immunization laws.

Licensee was reminded that CPR/1st Aide and Mandated Reporter training is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZAYMAK, DINA	FACILITY NUMBER: 015700158
	VISIT DATE: 03/02/2022

NARRATIVE

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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 reviewed guidance on operating safely during the Covid pandemic. Posters were present and the checking in process of children was reviewed.

Two Technical Violations were issued today, see LIC9102TV.

This home is recommended for an increase of capacity as of this day March 2, 2022. The report will remain on file for three years.

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

Exit interview conducted and report was reviewed with the licensee Dina Zaymak.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

LIC809 (FAS) - (06/04)

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