304313419-9-20-2022-06-CC-PRIS-CJFR7V-20220920124700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313419
Report Date: 09/20/2022
Date Signed: 09/20/2022 12:47:51 PM

Document Has Been Signed on 09/20/2022 12:47 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	PRISYAZHNYUK, YULIA		FACILITY NUMBER:	304313419
ADMINISTRATOR:	PRISYAZHNYUK, YULIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 870-2160
CITY:	IRVINE	STATE: CA	ZIP CODE:	92620
CAPACITY:	14	CENSUS: 6	DATE:	09/20/2022
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Yulia Prisyazhnyuk, Licensee		TIME COMPLETED:	01:30 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	Licensing Program Analyst, (LPA) P Rivas conducted an unannounced case management visit as part of an informal compliance conference held on 05/26/22 . A review of the Facility Personnel Report Summary on this date indicates all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today's inspection LPA toured home, reviewed 6 children files and reviewed Criminal record Clearances for individuals residing in the home. Ms. Prisyazhnyuk reported she is renting two bedrooms upstairs. LPA viewed criminal record clearances for the above individuals. LPA was also provided copy of their renter's agreement, copy of the licensee's lease which is not finished until 10/31/22. Licensee reports she will be the only person listed on this lease effective 11/01/22. An updated lease agreement will be provided to LPA by 11/01/22. The following deficiency is cited under the Health and Safety Code 1596.8595(c) & (d) Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services (c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b. (2) Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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: PRISYAZHNYUK, YULIA	FACILITY NUMBER: 304313419
	VISIT DATE: 09/20/2022

NARRATIVE

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that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
(3) The licensee shall require each recipient of the licensing report described in paragraph (1) pertaining to a complaint investigation to sign a statement indicating that he or she has received the document and the date it was received.
(4) The licensee shall keep verification of receipt in each child's file.
(d)(1) A licensed child day care facility shall provide to the parents or legal guardians of each child receiving services in the facility copies of any licensing document pertaining to a conference conducted by a local licensing agency management representative with the licensee in which issues of noncompliance are discussed.
(2) Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing document that the licensee has received during the prior 12-month period that pertains to a conference conducted by a local licensing agency management representative with the licensee in which issues of noncompliance are discussed.
(3) The licensee shall require each recipient of the licensing document pertaining to a conference to sign a statement indicating that he or she has received the document and the date it was received.
(4) The licensee shall keep verification of receipt in each child's file.
As of this date licensee will provide parents of enrolled children reports for 05/26/22, 05/04/22 and 02/08/22.

Upon receipt of this report, the licensee shall post any licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year. LPA provided LIC 9224 form.

Exit interview conducted with Licensee, Yulia Prisyazhnyuk. A copy of this report and the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights. A Confidential Names list (LIC811) was provided during this visit. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/20/2022 12:47 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
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: 09/20/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/21/2022 Section Cited	1 2 3 4 5 6 7	1596.8595 Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services.A licensed day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that
	8 9 10 11 12 13 14	documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b; this requirement was not met as evidenced by review of 5 out of 6 records didnt have lic 9224 in file . Licensee stated she did not provid copies	8 9 10 11 12 13 14
	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: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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