073405824-2-27-2020-02-CC-ASIH-BM7SED-20200227124833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405824
Report Date: 02/27/2020
Date Signed: 02/27/2020 12:48:41 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:	KUZINA, ELENA		FACILITY NUMBER:	073405824
ADMINISTRATOR:	KUZINA, ELENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 671-2915
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	14	CENSUS: 8	DATE:	02/27/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Elena Kuzina		TIME COMPLETED:	01:00 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 02/27/2020 at 11:15 AM Licensing Program Analysts (LPAs) Arminder Singh and Monica Mathur conducted an unannounced Annual/Random Inspection at Elena Kuzina's Family Day Care Home. LPAs met with Licensee and explained the purpose of today’s inspection. Present in the home were Licensee, one (1) Assistant and eight (8) day care children (2 infants, 6 preschool age). Facility is in compliance with required ratios/capacity today. Children were engaged in various activities under the supervision of the Licensee and Assistant in the gated backyard play area. Days and hours of operation are Monday - Friday from 7:00 AM - 6:00 PM. Adults over the age of 18 and residing in the home are the Licensee and Spouse. All adults have Criminal Background Check Clearances. At 11:20 AM LPAs toured the indoor and outdoor areas of the home during today's inspection. The house is a one story home that has an attached garage, three bedrooms, two bathroom, and backyard that has a gated pool. INDOOR SPACE: In Use Areas: Dining room, Playroom, Bedroom #1, and bathroom in the hallway, Living Room. Off Limit Areas: Master bedroom, Master bathroom, Bedroom 2, Kitchen, and Garage. The Licensee has a working telephone in the home. LPAs observed sufficient materials, toys, and play equipment for the day care children in the home. Furniture and equipment were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is orderly, and safe for the day care children. There is a fireplace (screened) in the Living room. There are no stairs inside the home. CONTINUED ON 809-C

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KUZINA, ELENA	FACILITY NUMBER: 073405824
	VISIT DATE: 02/27/2020

NARRATIVE

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OUTDOOR SPACE: In Use Areas: The Play Area of the backyard is on limits. The Play Area is a gated section of the backyard and the children are only allowed to play in that area. The backyard has a pool that is separated and made inaccessible by a locked gate. The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards.

LPA's observed a fully charged 3A40BC fire extinguisher in the Kitchen and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. Last fire/disaster drill was completed on 01/10/2020. All required postings including but not limited to Parent Rights Poster, Facility License, Emergency Disaster Plan were observed posted on a wall in the Day care Playroom area. The Licensee states that she does not transport children. Licensee states that she supplies snacks and meals to the children. Food storage area was observed to be sanitary and safe. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection.

FILE REVIEW:
At 11:50 AM eight (8) Children's files were reviewed and contained all required Licensing forms and records including but not limited to Receipt for Parents' Rights, Immunization record, Identification & Emergency Information, Consent for Medical Treatment, Health History.
One(1) Staff file was reviewed and contained all required Licensing forms. The mandated reporter training was current and expires on 04/2020. LPA's reminded that mandated reporter is to be renewed every two years.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times. The Licensee understands her capacity options and that she cannot have more than 8 children in the home at any time without at least two qualified adults present. Licensee also understands that she must comply with the ratio and capacity requirements of the Small Family Child Care Home license whenever she or a qualified adult is alone with the children.
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SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KUZINA, ELENA	FACILITY NUMBER: 073405824
	VISIT DATE: 02/27/2020

NARRATIVE

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LPA's reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.

LPA advised the Licensee of the required Mandated Reporter Training for Child Care Providers that all Licensees and employees are required to complete as of January 1, 2018. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

Individual Medical Services (IMS) policy was discussed. The Licensee stated that she currently does not have any one child in care who requires IMS. The following information regarding ADA 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

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” and “Safe Sleep Information Flyer” to Licensee.

There were No Deficiencies Cited During this inspection.

At 12:40 PM exit Interview was conducted, where this report was reviewed and discussed with Licensee. Licensee signed the report acknowledging receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED NEAR THE FRONT ENTRANCE TO THE HOME FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

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