304313419-7-9-2020-06-CC-KDEI-BRCL5K-20200709082715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313419
Report Date: 07/08/2020
Date Signed: 07/09/2020 08:27:28 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:	PRISYAZHNYUK, YULIA		FACILITY NUMBER:	304313419
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	07/08/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Licensee Prisyazhnuk Yulia		TIME COMPLETED:	12:45 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) Ketki Desai conducted an unannounced Case Management inspection via Face time today following an increase in capacity for the above facility. LPA met with Licensee Yulia Prisyazhnuk who guided analyst on a tour of the facility via face time. Also present during this inspection, is Licensee’s (spouse) Vlodislow Sluchenkor who provided care and supervision to 6 children including 2 infants, while licensee gave a tour of the home. This home is two story, with 3 bedrooms and 2.5 bathrooms. Licensee has designated the following areas of the home as off limits and inaccessible to children: upstairs, and garage. These areas have been made inaccessible by means of door lock and baby gate. Licensee has designated the large living room, dining areas, kitchen and downstairs bathroom located in the hallway for the care and supervision of day care children. Children nap in the designated area in the living area, the section is divided by a curtain. Older children nap on the wooden cot with proper mat padding and covered with linens, while infants nap in the crib. All linens are supplied by parents and are taken home on a weekly basis. Children use the bathroom in the hallway, younger children have individualized potty chairs as they receive toilet training. Diapers and wipes are provided by parents. Bathroom was observed to be clean and free of any hazards. No chemicals or cleaning supplies were observed. Children access the home through the side wooden door as an Entrance into the Day care area , which also leads into the backyard which is fenced and outdoor activities are held . The licensee provides food for children in care. Drinking water is available for children. The licensee states that 2 adults and 3 minor children currently reside in the home. Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020

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 4

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: 07/08/2020

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
26
27
28
29
30
31
32

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). The following was observed and reviewed during this inspection.

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. Poison is locked in a cabinet in the laundry room in the locked cabinets. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.
Kitchen is accessible to children, all the cabinets were locked and no sharp tools were observed.

Licensee stated there are no firearms on the premises. LPA advised anytime when firearms are present, they must be locked and stored separately from the ammunition. No swimming pool, spa or other bodies of water observed on the premises.
There is no fireplace in the home. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detectors were tested and are operable. Licensee has installed the new Fire Alarm system as recommended by Fire Marshall on the recent inspection.

The home is observed to be clean and orderly. Where children are less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. There are age appropriate toys available for children.

The licensee states that there is a land line on the premises and also a cell phone is used and stays at the facility during operating hours. (8.30 - 5.00 PM) Monday to Friday.

The outdoor play area was observed to be fenced. At the time of inspection, children were using the back yard for outdoor play time. There is a cemented area as well as grassy area where climbing structures are placed, covered patio area is also used for table top activities and if weather is permissible children do lunch activities on the tables. Out door area was observed to clean with age appropriate toys and equipments which were clean and free of any sharp objects. Wooden play structure, play house were in safe condition free of webs and dirt. Sand box is covered with a covering when not in use.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 07/08/2020

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
26
27
28
29
30
31
32

The licensee is observed to be operating within the license capacity limitations.

The Licensee have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR is valid through 01/16/2022. There are first aid supplies available.
Children’s records were not reviewed, during this Tele Face time inspection.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.

H&S 1597.622: 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. The licensee does/does not have proof of immunization against influenza, pertussis, and measles.

The following items were also discussed with licensee during this inspection.

All homes shall conduct fire and disaster drills at least once every six months, and document the drills.

PETS: There are No pets on the premises.

POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted.

PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.

SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.

Infant Care: Licensee does provide Infant care and copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics was emailed to the licensee with the report.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 07/08/2020

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.

Capacity Handout (Small & Large) was provided via email to the licensee

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

At this time, the licensee is in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

A new license for operating a Large Family Child Care Home shall be issued upon approval.

The report is being emailed to the Licensee, due to Covid 19 pandemic and LPA has requested a written acknowledgement of the report being read.

Appeal Rights were also emailed to the Licensee.

No deficiency cited during today's tele-inspection

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4