073407669-5-2-2019-02-CC-GRED-BBSTF3-20190502144051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407669
Report Date: 05/02/2019
Date Signed: 05/02/2019 02:41:08 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:	NIKITOVA, ANNA		FACILITY NUMBER:	073407669
ADMINISTRATOR:	NIKITOVA, ANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 533-8767
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	14	CENSUS:	DATE:	05/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Nikitova, Anna, Licensee		TIME COMPLETED:	02:50 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 05/02/2019 at 01:10 PM to conduct a health and safety inspection. The purpose of the inspection is to ensure the Licensee is compliant with Title 22, CCR and Health and Safety Code Statutes for Family Day Care Homes. During the inspection, LPA met with Nikitova, Anna, Licensee. LPA inspected all areas of the facility which are accessible to children. LPA made the following observations during the inspection: Capacity/Staffing: The facility operates as a Family Day Care (large), with a capacity of fourteen (14) children. On this date, there are ten (10) children in care of which, one (1) is an infant. There are two (2) staff persons present and the Licensee. The facility is in compliance with capacity limitations, child ratios and staffing levels. Accessible areas to children include: Living and Family rooms, Bedroom, Kitchen, Bathroom, Play yard. Inaccessible areas to children include: Private bedroom, Garage. Emergency Preparedness/Safety: Combination smoke and carbon monoxide detectors were available, tested and found to be operable. There is a fully charged fire extinguisher, with an approved classification of (2-A:10-B:C). First aid supplies available. Emergency Disaster Plan is dated, 12/01/2012 and is current, per Licensee. Fire and earthquake drills were last conducted on 10/24/18 and meet six (6) month requirement. The facility utilizes a land line and cellular telephone. Per the Licensee, there are no firearms present. The Licensee currently proves *Incidental Medical Services (IMS) for some children in care and is aware of IMS requirements. Training/Record Review: Licensee, and both staff assistants have criminal background clearances and are associated to the facility. Licensee has current, pediatric CPR/First Aid which expires on 10/2020. Licensee and both staff have completed Mandated Reporter training on file. - CONTINUED

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

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: NIKITOVA, ANNA	FACILITY NUMBER: 073407669
	VISIT DATE: 05/02/2019

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

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 and PINS: childcareadvocatesprogram@dss.ca.gov

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

· 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) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

Page: 3 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: NIKITOVA, ANNA	FACILITY NUMBER: 073407669
	VISIT DATE: 05/02/2019

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

Licensee does not currently provide care for infants, however, is considering. LPA discussed new Safe Sleep requirements with Licensee. LPA reviewed Facility Sketch and requested that “On” and “Off” areas be clearly identified on the sketch and a Licensee provided a copy to LPA for CCLD facility file.

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

LPA reviewed six (6) out of ten (10) children's records. Each was found to be complete.

Overall, the facility is clean, orderly and in good repair. The temperature is comfortable and there is adequate heating and ventilation. There are safe, healthful and comfortable accommodations, furnishings and equipment. There are no cleaning solutions, medications, toxins or other hazardous items accessible to children. There is a working toilet and sink. There are no pools, hot tubs or other bodies of water present.

Exit interview conducted. This Facility Evaluation Report discussed with the Licensee and signature obtained below. Notice of site visit was issued and 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.

FACILITY IN SUBSTANTIAL COMPLIANCE. NO DEFICIENCIES CITED ON THIS DATE.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3