304313282-1-18-2022-06-CC-AGOK-CAMULS-20220113144113

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313282
Report Date: 01/13/2022
Date Signed: 01/18/2022 09:39:41 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:	LOPATINA, ALEVTINA		FACILITY NUMBER:	304313282
ADMINISTRATOR:	LOPATINA, ALEVTINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 469-1935
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY:	14	CENSUS: 13	DATE:	01/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alevtina Lopatina		TIME COMPLETED:	03:00 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	An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Alanna Gontarek. LPA observed licensee, Alevtina Lopatina, Maria Onofre, Assistant, and Karime Ortiz, Assistant, caring for 13 preschool and school age children; which included (0) infants, (4) preschool age, and (9) school age children. Also present during this inspection was licensee's husband. Licensee was operating within the licensed capacity as specified on license. 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. During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. This is a 2 story 4 bedroom, 3 bathroom house. Off limits areas include the upstairs, including 3 bedrooms, 2 bathrooms, and a den, and is made inaccessible by a child gate at the bottom of the stairs. The front yard, two back yard side areas, and garage are off limits. The garage is made inaccessible by a locking door. The side areas in the backyard are made inaccessible by latching metal gates. The daycare areas include: Library, 2 living rooms, kitchen, one restroom, dining room, laundry room, and back yard. The children walk through the kitchen to the dining room/area. Licensee stated the children's primary areas are the 2 living rooms, dining room, and back yard. Per licensee, the library room (front bedroom) is used as an isolation area, and can be used as a nap area once daycare accepts infants and/or toddlers. There is a working carbon monoxide, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. LPA observed the fire extinguisher receipt purchased on 6/23/2021. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. LPA observed cleaning compounds stored in closet located in dining room on an upper shelf, and in the child's bathroom stored in a hanging basket, in the child's bathroom, inaccessible to children in care. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspections. There is a fireplace in the living room barricaded by wooden cover secured to wall with nails, and inaccessible to children in Page 1 of 4

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

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: LOPATINA, ALEVTINA	FACILITY NUMBER: 304313282
	VISIT DATE: 01/13/2022

NARRATIVE

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care. LPA observed knives to be inaccessible and stored in an upper cabinet in the kitchen. LPA observed posted forms including: Parent's Right poster, License and Emergency Disaster Plan posted at front entry way. LPA observed First Aid kits (2) stored in front closet. LPA observed children's storage/cubbies located in front closet. LPA observed poisons stored in the garage. At 9:58 a.m. LPA observed 7 insect killers in Licensee's garage, accessible to the children in care. Licensee did not lock garage door, leading from daycare room into garage, with a key or combination lock, and garage door was observed to be left open. Pictures were taken. Licensee immediately put a door cover over garage door, making garage and poisons inaccessible to children in care. During today’s inspection, LPA verified there is a working telephone service via cellular service. LPA observed no bodies of water on the premises.

The licensee does have a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation, LIC 700 and found to be in compliance. The licensee's Pediatric CPR expires on 3/19/22, and First Aid certification expires on 3/18/22. Licensee's Assistant, Maria's Pediatric CPR/First Aid certification expires on 1/13/2024. Licensee's Assistant, Karime's Pediatric CPR/First Aid certification expires on 6/6/2022.

Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee and both assistants were reviewed and within compliance. The licensee, and Licensee's assistants have proof of immunization against pertussis, and measles, and influenza. Licensee's assistants both have written declaration to decline Influenza on file.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. The licensee is exempt from this requirement due to the training not being available in Russian. Both Licensee's assistants completed the Mandated Reporter Training. Licensee's assistant, Maria's training expires on 5/6/2023. Licensee's assistant, Karime Ortiz's training expires on 6/6/2022.

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

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

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: LOPATINA, ALEVTINA	FACILITY NUMBER: 304313282
	VISIT DATE: 01/13/2022

NARRATIVE

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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

The licensee understands she must be present in the facility, must ensure children in care are supervised at all times, and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee states is registered through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website.

A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

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.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the licensee.

English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.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

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

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: LOPATINA, ALEVTINA	FACILITY NUMBER: 304313282
	VISIT DATE: 01/13/2022

NARRATIVE

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Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

· Always place infants on their backs for sleeping

· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold
PIN 21-29-CCP Face Covering Requirements and Guidance for Child Care Providers Regarding Coronavirus Disease 2019 (COVID 19) was provided and licensee was to continue to message the “Three W’s”: Wash your hands. Watch your physical distance. Wear a mask. This face covering guidance is for all individuals 2 years and older, except for the exceptions (child’s development, medical exemptions, etc.) that are outlined by CDPH.

Based on LPA's observations, the following violation was observed, and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Section 102417 (g)(4)(A), is being cited on the attached LIC 809D.

Exit interview conducted and report was reviewed with the licensee, Alevtina Lopatina. Appeal Rights and deficiencies were discussed. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5

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: LOPATINA, ALEVTINA	FACILITY NUMBER: 304313282
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that at 9:58 a.m., LPA Gontarek observed 7 insect killers in Licensee's garage, accessible to the children in care. Pictures were taken. Licensee did not lock garage door, leading from daycare room into garage, with a key or combination lock, and garage door was observed to be left open, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/14/2022
	Plan of Correction
1 2 3 4	Licensee immediately placed door cover over garage door to make garage inaccessible to the children in care. Per licensee, will store all poisons inside large utility box in the garage. Per licensee wll place 4 key locks on the utility box, making poisons inaccessible to children in care. Per licensee, will send a picture of the utility box via email to LPA by the due date 1/13/2022.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

LIC809 (FAS) - (06/04)

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