073408819-2-21-2020-02-CC-MMAR-BLZSKZ-20200221125735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408819
Report Date: 02/21/2020
Date Signed: 02/21/2020 12:57:42 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:	BELINSKAYA, IRINA		FACILITY NUMBER:	073408819
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	02/21/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Irina Belinskaya		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	On 02/21/20 at 11:30 AM Licensing Program Analysts (LPA) Monica Mathur and Arminder Singh conducted an unannounced Annual/Random Inspection at Irina Belinskaya's Family Day Care Home. LPA met with Licensee, Irina and explained the purpose of today’s inspection. Present in the home were Licensee and 5 day care children (1 infant, 4 preschool age). Facility is in compliance with required ratios today. Children were engaged in various activities under the supervision of the Licensee. Days and hours of operation are Monday - Friday from 7:00 AM - 6:30 PM. Adults over the age of 18 and residing in the home are the Licensee, Licensee's spouse, son. Licensee states a Helper comes to assist with children few days a week. All adults have Criminal Background Check Clearances, TB clearance and signed Criminal Record Statements LIC508 on file with Licensing Office. At 11:40 AM LPA toured the indoor and outdoor areas of the home during today's inspection. Entrance to the day care is through a gate on the front right side of the house, which leads into the right side yard. INDOOR SPACE: In Use Areas: Playroom, Bathroom down the hallway, Office (for napping). Off Limit Areas: Kitchen, Dining, Living, all 2 Bedrooms, Master bathroom. All off limits indoor spaces are inaccessible by way of door knob locks and gates. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is orderly, and safe for the day care children. LPA did not observe any wall heaters in the home. There is a fireplace inside the home that is barricaded/screened off. There are no stairs inside the home. OUTDOOR SPACE: In Use Areas: Right side yard, Portion of backyard Off Limit Areas: Rest of the backyard which is fenced off. There is a locked storage shed in the in-use area. The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. The yard was fenced and there were no bodies of water. CONTINUED ON NEXT PAGE 809-C

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: BELINSKAYA, IRINA	FACILITY NUMBER: 073408819
	VISIT DATE: 02/21/2020

NARRATIVE

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LPA observed a fully charged 2A10BC fire extinguisher in the closet in Play room and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. LPA reviewed a current Children Roster and obtained a copy. Last fire/disaster drill was completed on 01/07/20. All required postings including but not limited to Parent Rights Poster, Facility License, Emergency Disaster Plan were observed posted on a wall in the Play Room. The Licensee states that she does not transport children. Licensee states that she supplies snacks and meals to the children. Food storage area was observed to be clean . LPA discussed Healthy Beverages Act with the Licensee. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection.

FILE REVIEW:
At 12:00 PM five (5) Children's files were reviewed and contained all required Licensing forms and records including but not limited to Receipt for Parents' Rights, Immunization record, Identification & Emergency Information, Consent for Medical Treatment, Parent Notification for Additional Children in Care, Affidavit Regarding Liability Insurance, Health History.
Licensee and Assistant files contained Criminal Record and Child Abuse Index Clearance, TB clearance, Statement Acknowledging Requirement to Report Suspected Child Abuse, Employee Rights, Immunizations for Measles, Pertussis, Flu and required Mandated Reporter Training per AB1207. Licensee's certifications for CPR and First Aid are current and expire on 10/2020.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times. The Licensee understands her capacity options and that she cannot have more than 8 children in the home at any time.

LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.
CONTINUED ON NEXT PAGE 809-C

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: BELINSKAYA, IRINA	FACILITY NUMBER: 073408819
	VISIT DATE: 02/21/2020

NARRATIVE

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LPA advised the Licensee of the required Mandated Reporter Training for Child Care Providers that all Licensees and employees are required to complete as of January 1, 2018. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

Individual Medical Services (IMS) policy was discussed. This facility does not currently provide IMS to children in care. When any changes to the IMS plan is made, an updated 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.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” and “Safe Sleep Information Flyer” to Licensee.

Website links for free subscription to Quarterly Updates Newsletter:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
or
Send email to: childcareadvocatesprogram@dss.ca.gov

In the areas that were evaluated, no regulatory violations were observed.
At 12:30 PM exit Interview was conducted, where this report was reviewed and discussed with Licensee. Licensee signed the report acknowledging receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED NEAR THE FRONT ENTRANCE TO THE HOME FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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