343618014-8-19-2021-03-CC-TWAN-C62PW5-20210819114009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618014
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:40:18 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:	LYULKINA, YELENA		FACILITY NUMBER:	343618014
ADMINISTRATOR:	LYULKINA, YELENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 465-1568
CITY:	ELVERTA	STATE: CA	ZIP CODE:	95626
CAPACITY:	14	CENSUS: 0	DATE:	08/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Yelena Lyulkina		TIME COMPLETED:	11:45 AM

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	On Thursday, August 19th, 2021, at 10:45 AM Licensing Program Analyst (LPA) Tanya Washington met with the Licensee, Yelena Lyulkina, for the purpose of a 1 year Annual Required inspection. Today's inspection was conducted in Russian language. All individuals subject to criminal background review have obtained a criminal record clearance. Upon arrival there were no children in care, Licensee stated that last time she had day-care children in care was approximately one year ago. Operating hours are 24 hours a day, 7 days a week. Licensee is aware that she may not provide care to the same family for more than 24 hours. At 11:00 AM, LPA initiated a health and safety inspection of all areas accessible to children. Off-limits areas include master bedroom/ bathroom, daughter's room, both son's rooms, garage, backyard. LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children. There are no bodies of water on the premises. There is no fireplace or stairs in the home. Safe toys and play equipment are observed. Licensee stated that she takes children to a local park for outdoor play. The Licensee understands that in unfenced outdoor areas, 100% supervision of children is required. *Continued on LIC809-C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LYULKINA, YELENA	FACILITY NUMBER: 343618014
	VISIT DATE: 08/19/2021

NARRATIVE

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At 11:20 AM, LPA went over children’s files and other documentation pertaining to children's records. Licensee is aware of maintaining a children's roster. LPA went over the requirement of coundcting and logging drills, Licensee stated that as soon as she enrolls new children a drill will be conducted. Preventative health training, current pediatric CPR and First Aid certification was verified for the Licensee (expires 09/2022). Proof of AB1207 mandated reporter training is not applicable to as Licensee has limited English proficiency. LPA explained that the OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes 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 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

LPA discussed the Safe Sleep in Child Care and current Covid-19 guidelines for Sacramento County.

Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.

In the areas that were evaluated, there were no deficiencies at this time.

At 11:40 AM, LPA viewed and discussed this facility evaluation report with the Licensee.

LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice shall remain posted for 30 days for parental review.

The Licensee's signature on this form acknowledges receipt of this form.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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