073408658-2-5-2020-02-CC-RHOE-BLHS93-20200205124003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408658
Report Date: 02/05/2020
Date Signed: 02/05/2020 12:40:14 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:	VOLOKH, REGINA		FACILITY NUMBER:	073408658
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	02/05/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Volokh, Regina		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	Licensing Program Analyst, LPA, Hollie, met with the Licensee for the purpose of an announced Increase of Capacity Health and Safety Inspection. Present during the visit are six day care children, the licensee and the licensee's fingerprint cleared assistant, Vera Vasilyeva. This is a two story condo, (with a gate at the bottom of the stairs). The upstairs portion of the home is OFF LIMITS to children. The licensee received a fire clearance that indicates that the upstairs and the garage is OFF LIMITS. The licensee understands that children cannot be upstairs or in the garage at anytime. A tour of the residence was conducted. The OFF LIMIT areas to the downstairs portion of the home is the, laundry room and hall closet where the water heater and toxins are kept. The hall closet door is to remain closed. During today's visit, LPA witnessed a child go into the laundry area as the door was not closed. The licensee removed the child upon her noticing child in the laundry room and closed the door. LPA informed licensee that if the laundry room is OFF LIMIT'S, children are not to have access to the area and the door is to remain closed and inaccessible. Please see warning notice to licensee regarding this. PLEASE SEE NEXT PAGE FOR CONTINUED REPORT.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda Hollie	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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 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: VOLOKH, REGINA	FACILITY NUMBER: 073408658
	VISIT DATE: 02/05/2020

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

The licensee will ensure that the OFF LIMIT areas will be made inaccessible while children at all times. Children will have access to living room, dining area, family, hall bath and kitchen as well as fenced back and fenced front yard.
There is a working smoke detector, a charged 2a10bc fire extinguisher and a carbon monoxide detector. There are no guns in the home, per the licensee. There are no bodies of water such as pools, hot tubs or fountains on the premises, per the Licensee. The home has central heat and air.. There a fire place is covered to prevent access.

The Licensee is the only adult who resides in the home.

LPA provided and discussed at length paperwork that is to be maintained in both facility files and children’s files. The licensee was instructed that baby walkers, Johnny jumpers, exersaucers and similar items are not allowed in licensed care.
The licensee was instructed to post her license, emergency disaster plan, parent’s rights poster, personal rights as well as the earthquake preparedness check list along with documentation of disaster drills.
The licensee was informed that smoking is not allowed on the premises of day care homes. The licensee was notified both as a part of the Orientation and again today during this visit, that all person’s 18 years of age or older, who frequently visit, work or reside in the home, shall be fingerprint cleared and or associated to the facility, PRIOR TO BEING IN THE PRESENCE OF CHILDREN. Please see next page for continued report

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda Hollie	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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: VOLOKH, REGINA	FACILITY NUMBER: 073408658
	VISIT DATE: 02/05/2020

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

Additionally, person’s residing or working at the facility shall obtain a TB clearance, verification that required immunizations such as Measles, Whooping Cough and whether an Influenza shot has been given to the assistant or qualify for a written exemption by their physician. The licensee was informed that her assistant can be as young as 14 years old, but must be supervised at all times. The Licensee’s adult assistant(s), must complete the Mandated Reporter Training AB 1207and the training certificate must be placed in assistant’s file. http://www.madatedreporterca.com/

LPA discussed with the Licensee that Unusual Incident’s that occur at her home, must be reported by phone within 24 hours to Community Care Licensing at 510 622 2602 and in writing within seven days of the incident. The licensee was informed that she/he can download the Unusual Incident Report at our website at ccld.ca.gov.

The licensee was also advised to stay up to date with Title 22 Regulations and upcoming Regulatory laws by logging onto our website at CCLD.CA.GOV and review the Provider Information Notices also knowns as PINS.
During this visit, LPA provided License with a printed copy of the Child Care Provider’s Guide to Safe Sleep Practices/Concepts.

SEE NEXT PAGE FOR CONTINUED REPORT

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda Hollie	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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: VOLOKH, REGINA	FACILITY NUMBER: 073408658
	VISIT DATE: 02/05/2020

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

During this visit, LPA observed that the children's beds are located in the living room area, under a television system located on the wall. LPA encouraged licensee to move the beds away from under the television in case there is movement from the earth, however, the licensee stated that the television system was secure to the wall.

The Licensee was informed that if the facility is issued a deficiency. Plan of Corrections, must be made by the date provided or a civil penalty of $100 per day, will be assessed to the facility until the deficiency is corrected. Additionally, a repeat violation of a deficiency within one year, the facility will be assessed a civil penalty of $250 and $100 per day until corrected.
LPA encouraged the Licensee to review our website at the above address to stay up to date and informed on Laws and Title 22 Regulations as it relates to her day care business.

THE HOME IS READY TO BE LICENSED.

PLEASE SEE TECHNICAL ADVICE REGARDING CHILD BEING IN AN OFF LIMIT AREA.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda Hollie	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4