073408423-2-12-2020-02-CC-GRED-BLQTKP-20200212134815

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408423
Report Date: 02/12/2020
Date Signed: 02/12/2020 01:48:57 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:	MOLIBOGA, GALINA		FACILITY NUMBER:	073408423
ADMINISTRATOR:	MOLIBOGA, GALINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 768-7708
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	14	CENSUS: 11	DATE:	02/12/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	MOLIBOGA, GALINA, LICENSEE		TIME COMPLETED:	01:50 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 02/12/20 at 10:50 AM to conduct a health and safety inspection. The purpose of the inspection is to ensure the Licensee is in compliance with Title 22, CCR and Health and Safety Code Statutes. During the inspection, LPA met with MOLIBOGA, GALINA, 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 maximum capacity of fourteen (14) children. LPA OBSERVED AT 10:50 AM, eleven (11) children in care. There are six (6) infants. One of the infants will be two (2) in two weeks. One (1) infant must be removed from care and additional children in order to meet capacity requirements. The Licensee, has four (4) staff person present. The facility is over child ratios and staffing levels. The Licensee has designated the areas utilized for the day care as follows: On limit: areas where children are permitted: Entry level of the home: · Classroom/Family room · Bedroom (three) · Restroom · Yard Off limit: areas where children are not permitted: · Kitchen - CONTINUED

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

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: MOLIBOGA, GALINA	FACILITY NUMBER: 073408423
	VISIT DATE: 02/12/2020

NARRATIVE

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

Physical Plant: 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 are no pools, hot tubs or other bodies of water present.

Emergency Preparedness/Safety: Smoke and carbon monoxide detectors were not tested, because children were napping. There is a fully charged fire extinguisher, with a classification code of (2-A:10-B:C), which, meets fire marshal requirements. First aid supplies available. Emergency Disaster Plan is dated 04/14/16 and is current, per Licensee. Fire and earthquake drills were conducted on 12/02/19 and meet six (6) month requirement. The facility utilizes a land line telephone. Per the Licensee, there are no firearms present. The Licensee is not currently providing *Incidental Medical Services (IMS) for children in care.

Training/Record Review: LPA reviewed facility files. Licensee, and all adults residing in the home have criminal background clearances and are associated to the facility. Licensee has current CPR/First Aid training, which expires on 05/11/21. Licensee has completed Mandated Reporter training, on 05/15/18. Staff person K. Mineeva completed training on 06/01/18. I. Ruze, started work today, and is planning to complete training. Licensee provides care for infants. LPA discussed Safe Sleep requirements with Licensee and staff. Licensee has proper infant sleep devices available. More information on Safe Sleep can be found at: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep. Forms and training videos can be obtained on the CCLD website: www.ccld.ca.gov

* A DEFICIENCY HAS BEEN CITED AND A PLAN OF CORRECTION (POC) HAS BEEN ISSUED SEE PAGE LIC 809D. FAILURE TO CLEAR POC BY DUE DATE MAY RESULT IN CIVIL PENALTIES OF UP TO $100 PER DAY, PER VIOLATION. - CONTINUED

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: MOLIBOGA, GALINA	FACILITY NUMBER: 073408423
	VISIT DATE: 02/12/2020

NARRATIVE

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Exit interview conducted: This Facility Evaluation Report was issued to and discussed with the Licensee. Signature obtained. 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.

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.

* 102416.5 Staffing Ratio and Capacity

A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met

(1) Twelve children, no more than four of whom may be infants; or

(2) More than twelve and up to fourteen children only

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: MOLIBOGA, GALINA	FACILITY NUMBER: 073408423
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/12/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/24/2020 Section Cited	1 2 3 4 5 6 7	Staffing Ratio and Capacity. (1) Twelve children, no more than four of whom may be infants; or (2) More than twelve and up to fourteen children...THIS REQUIREMENT WAS NOT MET.
	8 9 10 11 12 13 14	AT 10:50 AM, LPA OBSERVED SIX (6) INFANTS AND CHILDREN UNDER SCHOOL AGED. THERE ARE FOUR (4) ADULTS PRESENT.	8 9 10 11 12 13 14	POC DUE DATE. FAILURE TO COMPLY MAY RESULT IN CIVIL PENALTIES OF UP TO $100 PER DAY, PER VIOLATION. FAX CORRECTION TO (510)622-2602 OR MAIL TO ADDRESS LISTED ABOVE.
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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: 02/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

LIC809 (FAS) - (06/04)

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