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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700322
Report Date: 03/09/2022
Date Signed: 03/09/2022 10:39:51 AM


Document Has Been Signed on 03/09/2022 10:39 AM - 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:ARMEEVA, ANNAFACILITY NUMBER:
015700322
ADMINISTRATOR:ARMEEVA, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 322-9126
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:14CENSUS: 0DATE:
03/09/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Anna ArmeevaTIME COMPLETED:
10:55 AM
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On 03/09/2022, Licensing Program Analysts (LPAs) Jaylena Miller and April Wright conducted an Announced Pre licensing Inspection. LPAs met with licensee Anna Armeeva and present for the inspection were the licensees fingerprint cleared and associated husband and adult daughter. The licensee plans to operate Monday-Friday from 8:00am-6:00pm for children ages 2 years old to 5 years old. LPAs conducted a health and safety inspection inside and outside with licensee.

The home is a two story home with 4 bedrooms including a master bedroom and master bathroom, 2 bathrooms one upstairs and one downstairs that will be used for daycare children, family room, kitchen with dining area, upstairs loft, garage and back yard which is completely fenced in.

The OFF-LIMITS areas are the entire upstairs area and the garage per fire clearance.

The ON-LIMITS areas are the family room which will be used as the main daycare area for children, downstairs bedroom that will be used as the nap room and isolation room if needed, the downstairs bathroom, kitchen and dining area. The backyard will be used as the outdoor play space and is completely fenced in. There is a trampoline located in the back yard on the right hand side that will not be used for daycare children.

LPAs observed the home to be neat and clean with central heating and ventilation for safety and comfort. All hazardous materials and toxins are kept out of reach from children and would be inaccessible to children during daycare hours. The home has a working smoke detector and carbon monoxide detector combo that is accessible throughout the home, fully charged fire extinguisher size 2A-10-BC located in the closet to the left of the front door, and first aid kit. Per licensee, there are no firearms on the premises.

The Licensee has received certificates of completion in Health and Safety on 10/20/2018, lead poison prevention training on 1/6/2022, the mandated reporter training on 9/22/2021 and CPR/First Aid is current and expires on 5/1/2023. LPAs discussed with licensee the CPR/First Aid and Mandated Reporter Training must be renewed every two years and CPR/First Aid needs to be EMSA approved. LPA reminded licensee a roster of the children must be properly maintained, and the fire/disaster drills every six months must be documented.

An approved fire clearance was received on 2/23/2022.

This home is recommended for a large family child care home as of 3/9/2022. Exit Interview conducted with Licensee Anna Armeeva and a copy of this report was given. Notice of Site visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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