343618095-5-24-2023-03-CC-MPAL-CS5TAP-20230524143353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618095
Report Date: 05/24/2023
Date Signed: 05/24/2023 02:34:34 PM

Document Has Been Signed on 05/24/2023 02:34 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	KUCHUGURNY, TATYANA & VICTOR		FACILITY NUMBER:	343618095
ADMINISTRATOR:	KUCHUGURNY, TATYANA&VICTOR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 813-9262
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95841
CAPACITY:	14	CENSUS: 10	DATE:	05/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tatyana and Victor Kuchugurny		TIME COMPLETED:	03:00 PM

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On May 24, 2023 at approximately 01:00 PM, Licensing Program Analyst (LPA) Michelle Pascual met with licensees Tatyana and Victor Kuchugurny for the purpose of a required annual inspection. During today’s inspection, there were 10 children present. All individuals subject to criminal background review have obtained a criminal record clearance.

A health and safety evaluation was conducted in all areas accessible to children. Off-limits areas include the master bedroom/bathroom, side yard, and partial garage that is attached to the converted playroom. LPA observed a full 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. LPA observed first aid kit. Per licensee, there are no weapons in the home. Toxic and hazardous items were inaccessible to children. Required postings were observed near the play room entrance. The living room, fireplace is barricaded.

During file review, LPA observed all necessary Children’s documents. LPA advised licensee to keep the time of each 15 minute check for sleeping infants on file for 3 years. LPA observed a current children’s roster and a fire drill log, last updated May 2023. LPA observed a current CPR and First Aid Certificate which expires August 2024. LPA advised Licensee to maintain current Preventative Health and Safety Training. LPA observed Licensees Mandated reporter training, expiring on March 2025 and June 2024.

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) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA available at: http://wwwada.gov/childqanda.htm

CONTINUED ON LIC809 - C…

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KUCHUGURNY, TATYANA & VICTOR	FACILITY NUMBER: 343618095
	VISIT DATE: 05/24/2023

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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/inspection-process.

Applicant 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 licensees and discussed the Child Care Licensing Safe Sleep webpage at http://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.

No deficiencies were cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Licensees, Tatyana and Victor Kuchugurny. This report and appeal rights were printed and provided to the Licensee.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

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