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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070215010
Report Date: 08/15/2019
Date Signed: 08/15/2019 02:54:15 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:NUDELMAN,B & HALEY,EFACILITY NUMBER:
070215010
ADMINISTRATOR:NUDELMAN,B. & NUDELMAN,E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 671-9738
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:12CENSUS: 8DATE:
08/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Nudelman, B & Nudelman, E.TIME COMPLETED:
03:15 PM
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3 Licensing Program Analyst, (LPA), R. Hollie, met with Licensee for the purpose of a Random Health and Safety Inspection. Present is are the Licensee's and eight children, four infants and four preschoolers. The OFF LIMITS of the home remain the main portion of the home located just inside of the family room/play room. Children have access to the Family Room, front room-located just inside the front door of the smaller portion of the home, one bedroom, and hall bath all which is located just outside of the family room . The licensee's state that they, Ms. Nudelman, B and Ms. Nudelman E, along with Kiriyan Kartsev are the only adults who reside on the premises, that is the large off limit home as well as the day care. Per the Licensee, there are no bodies of water on the premises nor are there guns on the premises. Poisons, detergents, cleaning compounds and medications are inaccessible to children. There is a working smoke detector and a charged fire extinguisher (2a10bc) as well as a carbon monoxide detector. The home is free of stairs. The home has toys, play equipment and materials for children. The licensee's understands that children are to be supervised at all times. The licensee is aware that children are not to be locked in cars or other areas of the home. PLS SEE NEXT PAGE FOR CONTINUED REPT.
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: NUDELMAN,B & HALEY,E
FACILITY NUMBER: 070215010
VISIT DATE: 08/15/2019
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The licensee's were informed that when or if either are temporarily absent from the home, a fingerprint cleared adult, who holds a current CPR/FA must be present in her absence. The licensee's shall always maintain the capacity specified on the license. The home appears to have healthful, safe and comfortable accommodations, furnishings and equipment for children. There is a current roster of children in care. The home conducts fire and disaster drills, per lciensee. The licensee documents immunization's as required. The licensee provides parents with a Notification of Parents Rights.
The Licensee understands that unannounced visits by CCL Employees, provided ID is shown and in the course of business, may enter and inspect areas of her home where she provides personal care and services to children.
The licensee understands that upon notice of the Department to remove an individual from the home, pursuant to H&S Code 1596.871(c)(2) or to exclude an individual from the home, pursuant to H&SCode 1596.8897, the licensee immediately removes the individual and prevents them from returning to the home or having contact with children in care. The licensee must ensure that all adults working, residing or volunteering in a licensed home, must obtain a criminal record review (fingerprint clearance) prior to being in the presence of children.
The licensee has current CPR/FA which expires 06-21. A sampling of Children's records were reviewed during this visit.

PLEASE SEE NEXT PAGE FOR CONTINUED REPORTI
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: NUDELMAN,B & HALEY,E
FACILITY NUMBER: 070215010
VISIT DATE: 08/15/2019
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Incidental Medical Services (IMS) policy was discussed. There are no children that require medication at this time.

?LPA discussed and advised licensee to check in with parent or guardians if children fail to arrive to the day care as scheduled.

LPA encouraged the Licensee to review our website at the above address at CCLD.CA.GOV to stay up to date and informed on Laws and Title 22 Regulations as it relates to her day care business, Particularly, the Provider Information Notices, known as PINS



THE LICENSEE WAS PROVIDED A COPY OF THEIR APPEAL RIGHTS (LIC 9058 12/15) AND THEIR SIGNATURE ON THIS FORM ACKNOWLEDGES RECEIPT OF THESE RIGHTS. LPA POSTED THE REQUIRED POSTINGS FOR PUBLIC VIEWING.

The licensee as informed that if the facility receives a deficiency, the facility must make the corrections by the date on the report (809-d) or the facility will receive a penalty of $100 per day until the deficiency is corrected. The Licensee was provided documentation regarding Safe Sleep Regulation Concepts as it relates to Infants. LPA discussed at length the importance of supervising infants at all times. LPA instructed licensee's that infants are not be left in the room alone with the door closed. The backyard remains fenced. The right side is off limits and there is a fence to prevent access. There are moveable toys in the backyard for the children. The home has a dog as a pet.

THERE ARE NO DEFICIENCIES CITED.

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
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