197410732-11-9-2023-58-CC-AMOY-CXES9L-20231109124054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197410732
Report Date: 11/09/2023
Date Signed: 11/09/2023 12:41:04 PM

Document Has Been Signed on 11/09/2023 12:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	NIKOLAENKO FAMILY CHILD CARE		FACILITY NUMBER:	197410732
ADMINISTRATOR:	SOFIA & LIANA NIKOLAENKO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 705-6398
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	14	CENSUS: 8	DATE:	11/09/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Irina Nikolaenko, Assistant		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival at 10:00am LPA met with Sofia Nokolaenko, Licensee and Irina Nikolaenko, Assistant. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. Irina provided translation for licensee. LPA toured the facility and inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. There were eight (8) children present upon arrival including four (4) infants. Per licensee the hours of operation are Monday-Friday 8:00am - 6:00pm. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

This is a one story single family dwelling with 3 bed rooms and 2 bath rooms and attached garage. Children in care use the bath room in the hallway.

Areas used by children are: Living room, family room, den area, one (1) bedroom (in hallway across from bathroom).

Off limit areas: two (2) bedroom, bathroom, and garage. The backyard is used as play area and observed to be fenced with toys, and free from hazards. There are no pets, no bodies of water.

LPA observed in bedroom used for children to have an infant rocker and infant bassinet, items that are not allowed in a licensed daycare home and can be a potential risk to children in care. The lice see removed the items to off limits and stated they will remove them from facility.

There are no exposed electrical outlets. rooms that are off-limits are made inaccessible by safety gates and locked doors. The kitchen was observed to have safety gates at both entrances. Per licensee the children dine in the kitchen area supervised by staff. LP observed cleaning agents to be stored in laundry room inaccessible to children in care. Knives and sharp kitchen items are in locked cabinet with safety lock. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. Page 1 – Report Continues

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIKOLAENKO FAMILY CHILD CARE	FACILITY NUMBER: 197410732
	VISIT DATE: 11/09/2023

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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher (2A10BC) was observed last serviced in May 2022. Licensee was reminded that fire extinguisher needs to be serviced yearly. LPA observed a fire place in den with barrier. The home maintains telephone service via cell phone line.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home.

Isolation area for sick children waiting to be picked up is in the living room, supervised and away from the other children.

There are 3 infants in care. 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 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.

Sleeping mats and play yards observed, Per licensee the infants sleep in the living room supervised by staff. Each infant has their own play yard. Toddlers sleep in bedroom in hallway with the door open.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. -------------------Page 2 – Report Continues

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIKOLAENKO FAMILY CHILD CARE	FACILITY NUMBER: 197410732
	VISIT DATE: 11/09/2023

NARRATIVE

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Staff and Children’s records were reviewed. One out of 6 children's files reviewed had missing Immunization record.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on the LPA's observations and records review Two "B" deficiencies will be cited today in accordance with California Title 22 Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee and Staff, Sofia Nikolaenko and Irina Nikolaenko. Appeal Rights were discussed and provided.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 11/09/2023 12:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NIKOLAENKO FAMILY CHILD CARE	FACILITY NUMBER: 197410732
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)

Operation of A Family Child Care Home

(d) The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations the licensee did not comply with the section cited above in that there was an infant rocker and infant bassinet accessible to children in care, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/09/2023
	Plan of Correction
1 2 3 4	The licensee removed the infant rocker and bassinet from the daycare room and stated they will remove it from the facility. Deficiency corrected during visit

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. 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 in 1 out of 6 records reviewed do not have immunization records which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/17/2023
	Plan of Correction
1 2 3 4	Per licensee, the immunization records for Child # 2 will be obtained form parent and sent to LPA by POC due date.

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: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

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