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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214200031
Report Date: 01/10/2020
Date Signed: 01/10/2020 12:12:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BYCHKOVA, VALENTINA & BYCHKOV, YURIFACILITY NUMBER:
214200031
ADMINISTRATOR:BYCHKOVA, VALENTINA & YURIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 884-9116
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:14CENSUS: 4DATE:
01/10/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Yuri Bychkov and Valentina BychokovaTIME COMPLETED:
12:30 PM
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A Required inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. A review of staff records on 01/10/20 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently three adults living in the home.

During today’s inspection the home and grounds were toured. The licensees (LS1 and LS2) were supervising four children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 7:30am to 6:00pm, Mon–Fri. The floor plan submitted by the licensees was reviewed and verified. The off-limits areas of the home are family/dining room, kitchen, the entire upper level of the home and the garage, and were made inaccessible by children's safety gates and a door latch. The children have access to the playroom on the lower level and the in-law unit in the front yard. The home was observed to be clean and orderly, and was at a comfortable indoor temperature of 68 degrees Fahrenheit. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. The licensees pediatric CPR and First Aid certifications were reviewed, and have expired, however, the Licensees stated that the vendor had to reschedule the Pediatric CPR and First Aid course. LPA issued an Advisory Note for this Technical Violation. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. LPA did not observe any poisons. The stairs/staircase in the front entrance were barricaded with a child safety gate. The fireplace has been made inaccessible with a screen. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensees have conducted an emergency drill within the past six months, last drill was documented on 10/23/19. The licensees stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The children use the front yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 588-5052
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BYCHKOVA, VALENTINA & BYCHKOV, YURI
FACILITY NUMBER: 214200031
VISIT DATE: 01/10/2020
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LPA reviewed staff (LS1 and LS2) records at 10:20am, and staff records reviewed revealed that LS1 is missing proof of immunity against the Measles. LS1 has requested additional time to obtain his required immunization record. LPA issued an Advisory Note for this Technical Violation. LPA requested AB 1207 Mandated Reporter Training certificates from LS1 and LS2, however, the Licensees were unable to furnish their certificates to LPA. LPA issued an Advisory Note for this Technical Violation. One child's (C1) record was reviewed at 10:50am; current immunizations and Notification of Parent’s Rights forms were on file. The licensees are not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the licensees. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 588-5052
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
LIC809 (FAS) - (06/04)
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