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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408819
Report Date: 09/02/2020
Date Signed: 09/02/2020 12:56:14 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:BELINSKAYA, IRINAFACILITY NUMBER:
073408819
ADMINISTRATOR:BELINSKAYA, IRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 408-0813
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:14CENSUS: 9DATE:
09/02/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Irina BelinskayaTIME COMPLETED:
09:30 AM
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On 09/02/20 at 09:00 AM Licensing Program Analyst (LPA) Monica Mathur conducted an Announced Case Management Inspection at Irina Belinskaya's Family Day Care Home. Inspection was conducted virtually due to COVID19 restrictions. LPA met with Licensee, Irina who has initiated the process of including an off limit area into day care use by children. Present in the home were Licensee, one (1) Assistant and nine (9) day care children (1 infant, 8 preschool age).

At 9:10 AM LPA toured the indoor space. Licensee wants to include the Master Bedroom (previously off limit area) to be licensed for use by day care children. Per Licensee, it will be used as a nap room for infants. LPA made observations in the Master Bedroom. There is a crib, master bed, two night stands and a dresser. Door to the attached Master Bathroom (off limit) will be locked during day care hours. Dresser drawers and cabinets were checked and Licensee understands she can not store sharps, poisons, medications or cleaning supplies that are dangerous to the health and safety of children in accessible areas of the bedroom.

In-Use Areas in the day care are: Play Room (formerly garage), Office Room, Bathroom in Hallway.
Off Limit Areas: Kitchen, Dining Area, Bedroom, Master Bathroom, Living Room.

Master Bedroom is approved to be included as In-Use Area in this day care home. This report was discussed and reviewed with Licensee. Licensee agreed to send a copy of updated Facility Sketch showing Master Bedroom as in-use space. A copy to be signed by LPA and emailed to Licensee to obtain her signatures. Signed Report to be sent back to CCL by end of 09/04/20.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 725-5998
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020
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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