073405975-5-16-2019-02-CC-GRED-BC8QX9-20190516123309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405975
Report Date: 05/16/2019
Date Signed: 05/16/2019 12:33:26 PM

COMPREHENSIVE INSPECTION

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:	VELITCHKO, SVETLANA		FACILITY NUMBER:	073405975
ADMINISTRATOR:	VELITCHKO, SVETLANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 516-6101
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	14	CENSUS: 9	DATE:	05/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Svetlana Velitchko, Licensee		TIME COMPLETED:	12:45 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	Licensing Program Analyst (LPA) Redmond arrived at the facility on 05/16/19 at 11:38 AM to conduct an unannounced, Annual/Random visit. On this date, LPA met with Svetlana Velitchko, Licensee. Capacity: The facility operates as a Family Day Care (large) and is licensed for fourteen (14) children. On this date, there are seven (7) pre-school children present and two (2) infants. The Licensee and another staff person are supervising the children. The facility is in compliance with staff to child ratios. The facility is separated into the following designated areas: "On Limit" (areas accessible to children in care) include: The area accessible to children is the downstairs area which, include: · Classroom (main day care area) – age appropriate toys and equipment · One bedroom – age appropriate toys and equipment and appropriate sleep cots and infant sleep · Hall · Restroom – toilet and sink, sanitary items, no cleaning solutions or hazards · Backyard (barricaded by fence) – pool, which, is gated "Off Limit” (areas inaccessible to children in care): · Private bedrooms · Garage locked Overall the facility is clean and appears in good repair. The facility is ventilated, and the temperature is comfortable. There are no cleaning solutions, toxins or other hazards accessible to children.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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: VELITCHKO, SVETLANA	FACILITY NUMBER: 073405975
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/30/2019 Section Cited HSC 1597.622(a)(1)	1 2 3 4 5 6 7	Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1	1 2 3 4 5 6 7	Licensee will: 1) Licensee and V. Velitchko will obtain required immunizations. 2) Licensee will email evidence of compliance to LPA by POC due date. NOTE: Failure to correct the deficiencies
	8 9 10 11 12 13 14	and December 1 of each year. Licensee did not meet this requirement as evidenced by review of records. LPA OBSERVED: There are no records of immunization for the Licensee or staff person, V. Velitchko. This poses an immediate risk to children in care if not corrected.	8 9 10 11 12 13 14	on or before the POC due date, may result in a civil penalty assessment. Civil Penalty Assessment of $100 per day, for each POC not cleared.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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: VELITCHKO, SVETLANA	FACILITY NUMBER: 073405975
	VISIT DATE: 05/16/2019

NARRATIVE

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Emergency Preparedness/Safety: The Licensee and all adults presently in the home have criminal background clearances and are associated with the facility. The Licensee has current pediatric first aid and CPR certification which expires in July 2019. There is a carbon monoxide detector, which, was installed during the visit. There is a smoke detector, which, LPA tested and found operable. The fire extinguisher is fully charged and has a classification of 2 A 10 B:C, which, meets State Fire Marshall standards. Emergency Disaster Plan was last updated on 07/16/2007 and is current, per Licensee. Emergency earthquake/fire drills were last conducted on 12/11/18 and meet six month requirement. First aid supplies available. Facility utilizes two cellular telephones for telephone service. There is a pool, which, is gated. There are no hot tubs or other bodies of water. There are no firearms, per the Licensee. The Licensee is/is not providing *Incidental Medical Services (IMS) services currently. Licensee provides care for infants and per the Licensee, she is aware of Safe Sleep Regulations.

Records Review: At 11:28 AM, LPA reviewed personnel records and observed that Licensee and her employee, V. Velitchko do not have immunization records on file. Per Licensee, they do not wish to take immunization. LPA printed a copy of the regulation requirement and explained the immunization regulations to the Licensee. Licensee was issued a deficiency for not complying with regulation.

Postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist. California Passenger Safety. If You See Something, Say Something.

FACILITY ISSUED NOTICE OF DEFICIENCY AND PLAN OF CORRECTION TO ENABLE THE LICENSEE TO COME INTO COMPLIANCE. SEE LIC 809 D page.

NOTE: Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100 per day until corrected.

Exit interview conducted. This Facility Evaluation Report, Plan of Correction, Appeal Rights and Notice of Site Visit were issued and discussed with Licensee signature obtained below. Notice of site visit shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty. A copy of this report shall be maintained for 3 years and available for public review upon request. Additional reminders and resources provided on next page.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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: VELITCHKO, SVETLANA	FACILITY NUMBER: 073405975
	VISIT DATE: 05/16/2019

NARRATIVE

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REMINDERS/RESOURCES

· CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

· Resource and Referral Agencies: https://www.ccrcca.org/resources/family-resource-directory/item/california-child-care-resource-referral-network

· The childcareadvocatesprogram@dss.ca.gov is the email address for the applicant to sign up to receive PINS.

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors, adults living in the home (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD suspected child abuse. Online training can be found at: www.mandatedreporterca.com.

· Licensee shall be present in the home and shall ensure children in care are supervised at all times. When temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise children in Licensee’s absence. Children shall not be left in parked vehicles.

· *LPA discussed IMS services and the requirement to update the plan of operation. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173. 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. Americans with Disabilities Act (ADA)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.

THIS CONCLUDES FACILITY EVALUATION REPORT

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

LIC809 (FAS) - (06/04)

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