304313143-6-19-2019-06-CC-WPOT-BDANF7-20190619102505

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313143
Report Date: 06/19/2019
Date Signed: 06/19/2019 10:25:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	HORNYAK, MACHIKO		FACILITY NUMBER:	304313143
ADMINISTRATOR:	HORNYAK, MACHIKO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 843-9325
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92647
CAPACITY:	14	CENSUS: 9	DATE:	06/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Machiko Hornyak, Licensee		TIME COMPLETED:	10:45 AM

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	An inspection was conducted at the facility by Licensing Program Analyst (LPA) Port. A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 2 adults (including the licensee) and 1 minor child living in the home. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. LPA observed 9 preschool age children in care being cared for by licensee and assistant, Bruna Goncalves Da Silva Brito. Also present in an off limits room, not interacting with children was Adult #1. Operating hours are 7:30 AM to 6:00 PM, Monday through Friday. The floor plan was verified. This is a single story 4 bedroom and 2 bathroom home. Off limits areas are made inaccessible by means of door knob covers and high latches. All of bedrooms, the kitchen, garage and master bathrooms are off limits. The main day care areas are the living room and enclosed sun room. Parents and children enter the facility by walking on the left side yard of the home and entering through the sun room door accessed in the backyard. The children use the backyard as the outdoor play area, and it is completely fenced. The outdoor play area is free from hazards. There are no bodies of water on the premises. There is a fireplace in the living room screened by a fireplace cover and inaccessible to children in care. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisonous items are locked in the garage. The home provides safe toys, equipment, and materials. During today’s inspection each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. The facility has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HORNYAK, MACHIKO	FACILITY NUMBER: 304313143
	VISIT DATE: 06/19/2019

NARRATIVE

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The licensee understands she must present in the home and ensures that children that children in care are supervised at all times. The licensee understands children are not to be left in parked vehicles. The licensee understands when temporarily absent from the home, she arranges for a substitute adult to care for and supervise children in her absence.

The licensee's pediatric CPR/First Aid certification is current, which expires 01/05/2021. Proof of immunization against influenza (or written decline) pertussis and measles for licensee and assistant present during today's inspection were reviewed and within compliance of SB 792.

Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. The licensee and assistant do not have proof of compliance as specified in A.B. 1207.

The facility has an updated children’s roster. Children’s records for the nine children present during today's inspection were reviewed for a signed acknowledgment of parents’ rights (LIC 995A) and a completed copy of the California School Immunization Record (CDPH 286). In the areas reviewed, the children's records were within compliance.

This facility provides Incidental Medical Services -IMS. LPA reviewed storage of medication, equipment/supplies, and reviewed children's, personnel, and administrative records. 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 .

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HORNYAK, MACHIKO	FACILITY NUMBER: 304313143
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/19/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/09/2019 Section Cited HSC 1596.8662	1 2 3 4 5 6 7	Mandated Reporter Training. Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	LPA provided licensee with written instructions for mandated reporter training from the Fall 2017 Quarterly Update. The licensee stated she and assistants will complete mandated reporter training and a copy of the completion certificate will be sent to our office by the due date of 07/09/2019.
	8 9 10 11 12 13 14	The licensee stated she was not aware of this requirement. The licensee and assistant present today do not have proof of completion of mandated reporter training. This poses a potential safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HORNYAK, MACHIKO	FACILITY NUMBER: 304313143
	VISIT DATE: 06/19/2019

NARRATIVE

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Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A hard copy of the Spring 2019 Child Care Quarterly Update was provided to the licensee. A hard copy of the Department of Social Services Lead Information brochure was explained and provided to the licensee.

A hard copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The following deficiency of the California Code of Regulations, Title 22; Division 12, was observed and cited today: no proof of Mandated Reporter Training on file, Health and Safety Code (HSC) 1596.8662) see LIC 809D.

Inspection, report review and exit interview was conducted. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019

LIC809 (FAS) - (06/04)

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