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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313419
Report Date: 05/02/2019
Date Signed: 05/02/2019 02:51:32 PM

COMPREHENSIVE INSPECTION
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:PRISYAZHNYUK, YULIAFACILITY NUMBER:
304313419
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 9DATE:
05/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Yulia PrisyazhyukTIME COMPLETED:
03:30 PM
NARRATIVE
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An inspection was conducted at the facility by LPA, Dean Valencia. A review of staff records 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 presently 3 adults living in the home.

During today’s inspection the home and grounds were toured and the licensee was not operating within the licensed capacity nor a compliant ratio. There were 7 infants in care, and 2 preschool age children in care during the inspection, along with the licensee, licensee's husband and an assistant. This places the facility over its licensed capacity of 8, and out of ratio with too many infants. The ratio violation is cited on a complaint investigation report, being done concurrently with today's annual inspection. Operating hours are 7am to 6pm, Mon–Fri. The floor plan was verified. Off limits areas are made inaccessible by means of baby gates and door knob covers. The staircase is off limits. The licensee's pediatric CPR/First Aid certification is current, which expires 3/2020. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisonous items are not stored on site, and none were observed during today's inspection. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home. The licensee did not have a current roster of children in care. 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. 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. Children's records were reviewed, and found to be missing some documentation. 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:
(continued on LIC809C)
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
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 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: PRISYAZHNYUK, YULIA
FACILITY NUMBER: 304313419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2019
Section Cited
CCR
102417(g)(8)
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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

The facility did not have a roster. This is a potential threat to the children's health and safety.
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The licensee and licensee's spouse stated that they will submit a current roster to LPA via email, by 5/3/19, and continue to maintain a current roster from now onward.
Type B
05/16/2019
Section Cited
CCR
102418(g)
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The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

8 of the nine children did not have current immunization records available to review.
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The licensee and licensee's spouse stated that they will submit current immunization records of the 8 children, to LPA via email, by 5/16/19, and continue to maintain these records from now onward.
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This is a potential threat to the children's health and safety.
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Type B
05/16/2019
Section Cited
CCR
102421(b)
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The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7).

Two of the nine children present did not have Emergency Information forms available for review. This is a potential threat to the children's health and safety.
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The licensee and licensee's spouse stated that they will submit emergency/information records of the 2 children, to LPA via email, by 5/16/19, and continue to maintain these records from now onward.
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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC809 (FAS) - (06/04)
Page: 4 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: PRISYAZHNYUK, YULIA
FACILITY NUMBER: 304313419
VISIT DATE: 05/02/2019
NARRATIVE
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Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm . Proof of immunization against pertussis, influenza (or written declination), and measles for licensee(s)/assistants/volunteers were reviewed and within compliance of SB 792, although an assistant present assisting with care did not have record of immunization's. The licensee was advised on how to receive notifications about quarterly updates, and provided with the Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Safe Sleep Regulation Concepts (4/2018) was provided for the Licensee.
Beginning January 1, 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.

Exit interview was conducted, and report was reviewed and discussed. Notice of Site Visit was posted during the visit. The licensee 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 per day. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional manager, address is above on the report. The licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. This report is to be on file and accessible for public review at the facility for at least 3 years.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.
Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC809 (FAS) - (06/04)
Page: 2 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: PRISYAZHNYUK, YULIA
FACILITY NUMBER: 304313419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2019
Section Cited
CCR
102416.5(a)
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The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

LPA observed nine children in care during the inspection. This is over the licensed capacity of 8, and an immediate threat to the children's health and safety.
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The licensee and licensee's spouse stated that they will immediately begin disenrolling children to return to compliance. An email will be sent to LPA detailing the plan for returning to capacity compliance.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC809 (FAS) - (06/04)
Page: 3 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: PRISYAZHNYUK, YULIA
FACILITY NUMBER: 304313419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2019
Section Cited
HSC
1597.622
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Commencing September 1, 2016, 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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The licensee and licensee's spouse stated that they will submit record of immunizations to LPA via email, by 5/16/19, and continue to maintain a this documentation for all individuals assisting with care of the children, from now onward.
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An adult assistant present assisting with care, does not have record of immunization against pertussis or measles. This is a potential threat to the children's health and safety.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5