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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617980
Report Date: 10/21/2019
Date Signed: 10/21/2019 09:49:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:LESHCHIK, SVETLANAFACILITY NUMBER:
343617980
ADMINISTRATOR:LESHCHIK, SVETLANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 726-7941
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 2DATE:
10/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Svetlana LeshchikTIME COMPLETED:
09:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tanya Washington met with Licensee, Svetlana Leshchik for the purpose of an unannounced annual/random inspection. LPA observed care and supervision of two children. All individuals subject to criminal background review have obtained a criminal record clearance. Facility operates Monday- Thursday from 6 AM to 6:00 PM.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include entire upstairs, downstairs bedroom to the left of the hallway, laundry room, and garage. LPA observed a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. There are no accessible bodies of water on the premises. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. LPA observed that the last fire drill was logged in May, 2018. Licensee could not locate a copy of the children's roster form LIC9040.

Children's records were reviewed. LPA observed signed Parents Rights form LIC995A and Consent for Medical Treatment LIC627. Licensee's CPR and First aid certification expired February, 2019. LPA reviewed Licensee's vaccines, she declines the influenza vaccine.

LPA verified that the annual Licensing fees are current.

Report continues on LIC809-C.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: LESHCHIK, SVETLANA
FACILITY NUMBER: 343617980
VISIT DATE: 10/21/2019
NARRATIVE
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This provider is currently not providing IMS services to children in care. 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: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this report.

LPA reviewed Safe Sleep Regulation Concepts with Licensee and reviewed appropriate infant equipment used in child care homes.

Title 22 deficiencies are cited on the subsequent page of this report LIC809D. Appeal Rights were provided and an exit interview was conducted. A Notice of Site Visit was posted and must remain posted for 30 days.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LESHCHIK, SVETLANA
FACILITY NUMBER: 343617980
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2019
Section Cited

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The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced; Licensee's CPR and First Aid expired 02/19. This is a potential risk to children in care.
Type B
11/21/2019
Section Cited

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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. This requirement is not met as evidenced; Licensee could not locate a copy of the children's roster during the visit. This is a potential risk to the health and safety of children in care.
Type B
11/21/2019
Section Cited

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Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
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This requirement is not met as evidenced; LPA observed that the last drill was documented in May, 2018. This is a potential risk to the health and safety of children in care.
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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: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3