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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408658
Report Date: 11/06/2019
Date Signed: 11/06/2019 02:43:20 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, REGINAFACILITY NUMBER:
073408658
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
11/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Regina VolokhTIME COMPLETED:
03:04 PM
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3 LPA, Hollie, met with the Licensee for the purpose of a Random Health and Safety Inspection. Present in care today are five day care children and the Licensee's fingerprint cleared assistan,tVera Vasilyeva. Per the licensee, she is the only person who resides in the home. A tour of the ON LIMITS of the home was conducted. Children have access to the living and dining area, kitchen, 1/2 bath and family room. The licensee understands that the OFF LIMITS portion - upstairs garage and front court yard- of the home must remain inaccessible to children at all times. There is a gate at the bottom of the stairs. There are no bodies of water or fire arms on the premises, per the licensee. The Licensee is present in the home and ensures that children are supervised. The Licensee understands that children are not to be placed in locked cars.

The home is orderly with heating and ventilation for safety and comfort. Poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children, are inaccessible during this visit. Fireplaces and open face heaters are screened to prevent access by children. There is a charged 2a10bc fire extinguisher and a working smoke detector as well as a carbon monoxide detector in the home.

PLEASE SEE NEXT PAGE FOR CONTINUED REPORT.

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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: VOLOKH, REGINA
FACILITY NUMBER: 073408658
VISIT DATE: 11/06/2019
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The home has toys, play equipment and materials for children. The licensee is aware that when she is temporarily absent from the home, she must ensure that a fingerprint cleared adult is present with current CPR/First Aid and have verification of immunization that includes Measles, Pertussis and Influenza (optional) or provide medical exemption signed by their Physician. The facility is operating within her licensed capacity today. There are comfortable accommodations, furnishings and equipment for children. There is a current roster and LPA took a photo of the roster. The licensee has current CPR/First Aid which expires July 2021.

The licensee understands that all person’s 18 years of age or older, who frequently visits, works or resides in the home, shall be fingerprint cleared/associated to the home and have immunization's, PRIOR to being in the presence of children. LPA reviewed a sampling of children’s records for documentation of Immunization and Notification of Parents Rights.

The home conducts and documents fire drills as required. The licensee was informed that parents should shown the Disaster Plan and be informed of the Relocation Sites in case the Family Day Care home has to evacuate.

LPA provided Licensee with a printed copy of the A Child Care Provider’s Guide to Safe Sleep/Best Practices documentation and discussed the material related to children under the age of one. The licensee states she understands the concepts and is currently practicing safe sleep with day care children.

PLEASE SEE NEXT PAGE FOR CONTINUED REPORT

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
Page: 2 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: VOLOKH, REGINA
FACILITY NUMBER: 073408658
VISIT DATE: 11/06/2019
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The licensee has the required immunization's on file for all but one child. The licensee is being advised, in writing, to obtain the immunization and document the file.

The back yard continues to be fenced. Children play in the fenced back court yard. There are toys available that appear to be in good condition without pointed or loose parts.

LPA encouraged the Licensee to review our website at CCLD.CA.GOV to stay up to date and informed on Laws and Title 22 Regulations website for Provider Information by the PINs. During the visit, LPA trained the licensee how to look up her own facility on CCLD's transparency website.



LICENSEE WAS INFORMED THAT IF THE FACILITY IS ISSUED A DEFICIENCY NOTICE, THE PLAN OF CORRECTION MUST BE CORRECTED 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 WILL BE ASSESSED IN THE AMOUNT OF $250 AND $100 PER DAY UNTIL CORRECTED. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and is being encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

THE LICENSEE WAS PROVIDED A COPY OF THEIR APPEAL RIGHTS (LIC 9058 12/15) AND THEIR SIGNATURE ON THIS FORM ACKNOWLEDGES RECEIPT OF THESE RIGHTS. LPA POSTED THE REQUIRED POSTINGS FOR PUBLIC VIEWING THAT MUST REMAIN POSTED FOR 30 DAYS.

NO DEFICIENCY SITED DURING THIS VISIT, HOWEVER, THE LICENSEE WAS GIVEN AN ADVISEMENT NOTICE REGARDING IMMUNIZATION.

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
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