343618081-1-27-2022-03-CC-ATIY-CB3NYB-20220127095229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618081
Report Date: 01/27/2022
Date Signed: 01/27/2022 09:52:36 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:	SHURAYEV, NADEZHDA		FACILITY NUMBER:	343618081
ADMINISTRATOR:	SHURAYEV, NADEZHDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 363-1038
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95827
CAPACITY:	14	CENSUS: 2	DATE:	01/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Shurayev, Nadezhda		TIME COMPLETED:	10:00 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 January 27, 2022 at 8:45 AM, Licensing Program Analyst (LPA) Alize Tillery met with licensee Nadezhda Shurayev for the purpose of an annual required 1 year inspection. The facility’s days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. LPA observed care and supervision of 3 children supervised by the Licensee. All individuals subject to criminal background review have obtained a criminal record clearance. Licensee offers transportation services. A health and safety evaluation was conducted in all areas accessible to children. Off limit areas consist of: the entire upstairs floor, the garage, the side yard and shed. LPA observed a 2A10BC fire extinguisher, first aid kit and functioning smoke and carbon monoxide detectors. Per licensee, there are no weapons in the home. No children were observed in parked cars. Toxic and hazardous items are inaccessible to children, and safe toys were observed. LPA observed a pool fully enclosed by a fence. In addition, the gate swings away from the pool, self-closes and has a self-latching device located no more than six inches from the top of the gate. LPA reviewed children’s files for the 2 present day care children; files were observed to be complete. Required postings and the children’s roster were observed. Licensee has record of conducting fire drills at least every six months. Per record, last drill was conducted on 01/12/2022. LPA observed children 2 years and above wearing masks, observed COVID19 posters and current guidelines were discussed. LPA observed licensee’s CPR and First Aid card which expires 10/2022. Licensee’s and all other adult files were reviewed and were observed to be complete. LPA discussed the requirement of renewing mandated reporter training every 2 years. Licensee’s Mandated Reporter Training is current and expires on 12/9/2023. Continued on LIC809C…

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022

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

FACILITY NAME: SHURAYEV, NADEZHDA	FACILITY NUMBER: 343618081
	VISIT DATE: 01/27/2022

NARRATIVE

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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 submitting 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

In the areas observed, no deficiencies were.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Licensee, Nadezhda Shurayev.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022

LIC809 (FAS) - (06/04)

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