073409090-10-13-2021-02-CC-MMAR-C7RW4M-20211013165744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409090
Report Date: 10/13/2021
Date Signed: 10/13/2021 05:00:07 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:	LEVINA, VALENTINA & MOGILYANSKIY, MIKHAIL		FACILITY NUMBER:	073409090
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 7	DATE:	10/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Valentina Levina		TIME COMPLETED:	05:00 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 10/13/21 at 1:45 pm Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual Inspection. LPA met with Licensee, Valentina and explained the purpose of today’s inspection. LPA was granted permission to enter the facility. Present in the home were Licensee, Helper, Daughter-in-law and 7 day care children (all preschool age). Facility is not in compliance with required ratios today. Days and hours of operation are Monday - Friday from 7:30 am - 6:00 pm. Licensee states co-licensee does not reside in the home anymore. At 2:00 pm LPA toured the indoor spaces of the home with Licensee: Entrance to the child care area is through the left side of the home. INDOOR In Use Areas: Large Family room, Play room, Bathroom next to childcare entrance LPA observed sufficient materials, toys, and play equipment for the day care children in the home. Children were napping under the supervision of the Licensee and Helper. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premises during today’s inspection. The home is sanitary, orderly, and safe for the day care children. LPA did not observe any wall heaters in the home. There are no stairs inside the home. The Licensee has a working telephone in the home. LPA observed a fully charged fire extinguisher and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. LPA reviewed the Children Roster, Emergency Disaster Plan LIC610A. 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. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection. continued

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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: LEVINA, VALENTINA & MOGILYANSKIY, MIKHAIL	FACILITY NUMBER: 073409090
	VISIT DATE: 10/13/2021

NARRATIVE

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At 2:30 pm outdoor space was inspected
OUTDOOR In Use Areas: Play yard on left side of the home
Off Limit Areas: Rest of the yard which is gated, locked, Pool area
The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. The yard was fenced. The pool is located in the off limit area, observed to be fenced and locked. Children do not go to the off limit area outside.

FILE REVIEW:
At 3:00 pm Children's files were reviewed and contained Notification of Parents' Rights LIC995A, Immunization record, Identification & Emergency Information LIC700, Consent for Medical Treatment LIC627, Affidavit Regarding Liability Insurance LIC282. Records show Helper MARTA KRAPIUNITSKAYA has been working in the facility and caring for children for past 2 months but is not associated to the license.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a 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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

continued

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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: LEVINA, VALENTINA & MOGILYANSKIY, MIKHAIL	FACILITY NUMBER: 073409090
	VISIT DATE: 10/13/2021

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, regulatory violations were observed. Citations are issued on 809-D pages of this report.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. At 4:15 pm Exit interview conducted and report was reviewed with the licensee Valentina and daughter-in-law.

Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be POSTED AND PROVIDED to each existing parent by the end of today or next day child is in care, and to the parent of children enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

end of report

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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: LEVINA, VALENTINA & MOGILYANSKIY, MIKHAIL	FACILITY NUMBER: 073409090
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(d)(2)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 102370(j) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above. Helper MARTA KRAPIUNITSKAYA has been employed and providing care, supervision for children but is not associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/14/2021
	Plan of Correction
1 2 3 4	By end of POC Due Date licensee agreed to get Helper's fingerprints associated to the licensee. Licensee to also submit written statement of her understanding of the regulation. She understands that Marta will not return to work in the facility until she is associated.

Type A

Section Cited

CCR

102416.5(b)(3)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation andrecord review, the licensee did not comply with the section cited above. Present today during inspection were 7 children, all preschool age. Per CCL regulations, there should be a school age child present who is currently enrolled in elementary school or at least age 6 when providing care for more than 6 children, This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/14/2021
	Plan of Correction
1 2 3 4	By end of POC Due Date Licensee agreed to submit written statement of her understanding of the regulation. Licensee to submit a plan of how she will ensure facility stays in compliance with ratios moving forward.

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: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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: LEVINA, VALENTINA & MOGILYANSKIY, MIKHAIL	FACILITY NUMBER: 073409090
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. She did not maintain an updated Child Roster which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2021
	Plan of Correction
1 2 3 4	By end of POC Due Date licensee agreed to submit a copy of updated Roster to CCL.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC809 (FAS) - (06/04)

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