073405975-5-5-2023-02-CC-THAR-CRJNVE-20230505104749

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405975
Report Date: 05/05/2023
Date Signed: 05/05/2023 10:48:10 AM

Document Has Been Signed on 05/05/2023 10:48 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, 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:	05/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	SVETLANA VELITCHKO		TIME COMPLETED:	11:00 AM

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 Tasha Alexander met with licensee Svetlana Velitchko for an unannounced 1 YEAR/REQUIRED inspection . Licensee, her husband Valeri and 9 preschool age children are present for today's inspection. LPA toured the facility and backyard for a health and safety inspection. The children's files were reviewed and are found to be complete.. There is a fully charged 2A10BC fire extinguisher, a working smoke alarm and a working carbon monoxide detector in the home. all were inspected/tested and found to be in working condition. There is a working telephone in the home, no change in phone number. Per licensee there are no fire arms on the premises. There is a swimming pool located in the backyard that has a mesh 5 ft latched fenced surrounded it that meets State Fire Marshall standard. There are no other bodies of water. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR & 1ST cards which expire 1/2024 respectively..The off-limits areas are all bedrooms and garage. The areas will be inaccessible to children in care by closed and/or locked doors and visual supervision. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates. Licensee [or facility representative] 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.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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 5

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: 05/05/2023

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
26
27
28
29
30
31
32

A review of staff records on 5/1/23 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Licensee and assistant/husband do not have immunization records in file today

Today the newly implemented mandatory mandated reporter training course has also been discussed. today both licensee and huband do not have the mandated reporter training certificates in tile.

CONTINUED ON 809-C

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: 05/05/2023

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
26
27
28
29
30
31
32

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

PLEASE SEE ATTACHED 809-D FOR CITATION

An exit interview was conducted. A notice of site visit was posted.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 05/05/2023 10:48 AM - It Cannot Be Edited

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: 05/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(c)

Administration of Child Day Care Licensing

(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED THE LICENSEE AND HUSBAND/ASSISTANT DO NOT HAVE THE MANDATED REPORTER CERTIFICATE IN FILE TODAY
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	LICENSEE AND HUSBAND WILL TAKE THE MANDATED REPORTER TRAINING COURSE AND SUBMIT COPIES OF THE CERTIFICATES TO COMMUNITY CARE LICENSING BY 5/19/2023

Section Cited

Administration of Child Day Care Licensing


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 05/05/2023 10:48 AM - It Cannot Be Edited

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: 05/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) 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 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED THE LICENSEE AND HUSBAND/ASSISTANT DO NOT HAVE IMMUNIZATION RECORDS IN FILE TODAY.
	POC Due Date: 05/26/2023
	Plan of Correction
1 2 3 4	LICENSEE AND HUSBAND WILL OBTAIN THEIR IMMUNIZATION RECORDS AND SUBMIT COPIES TO COMMUNITY CARE LICENSING BY 5/28/23. RECORDS MUST SHOW PROOF OF MEASLES VACCINE (MMR) AND PERTUSSIS (T-DAP) VACCINE AND A FLU DECLARATION FOR BOTH MUST ALSO BE SUBMITTED .

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5