343618630-8-3-2023-03-CC-EBAN-CUCRVJ-20230803132136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618630
Report Date: 08/03/2023
Date Signed: 08/03/2023 01:21:42 PM

Document Has Been Signed on 08/03/2023 01:21 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	TIMOFEYEV, NATALIE		FACILITY NUMBER:	343618630
ADMINISTRATOR:	TIMOFEYEV, NATALIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 729-1148
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	14	CENSUS: 8	DATE:	08/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Natalie Timofeyev, Licensee		TIME COMPLETED:	01:35 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	On August 03, 2023, an unannounced annual/random inspection was made today by LPA's Eduardo Barragan and Mandie Goodwin. Present at time of inspection were licensee, 8 day care children. LPA's spoke with Natalie Timofeyev, Licensee. LPA's tour of the home was conducted the inspection, inside and outside, as shown on the facility sketch is conducted. Licensee states there are no weapons or firearms in the home. There was no spas or pools in the home. LPA's observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. There was a fireplace in the home, but it is in a off limits area. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations. Currently, Licensee does have 1 dogs. The Licensee was reminded to ensure safety and appropriate supervision If the dogs are ever near the children. There are stairs in the home; however, it is in an off limit area. Toys and play equipment that were observed appeared to be safe. There is a working telephone. Adequate supervision is being provided during this inspection. Children are supervised when outside in any unfenced play area. There was 0 infant under 12 months old present. Children's area is on the right side of the home, through the right side gate. Additionally, there is a Kids room and bathroom on the right hand side of the home. The kid room is the only area of home the children are allowed to enter. Off-limit areas: Entire second floor, all of the down-stairs minus the kid room and the kids bathroom inside of the day-care room. Licensee was notified that prior to any changes of an on-limit to an off-limit area, or vice versa, the department must be notified.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Eduardo Barragan	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TIMOFEYEV, NATALIE	FACILITY NUMBER: 343618630
	VISIT DATE: 08/03/2023

NARRATIVE

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Pediatric CPR/FA is current with expiration date of 03/25. Fire and disaster drills could not be provided to LPA's. Five child's records were reviewed during this inspection.

LPA's discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 7 AM to 6 PM; Monday thru Friday and other hours as arranged. Licensee stated that she does not transport children.

Natalie Timofeyev, 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 Natalie Timofeyev, 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 Natalie Timofeyev, 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.

LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com . Current until 03/2024.

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) 514-0301 (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 .No children currently on medication.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Eduardo Barragan	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TIMOFEYEV, NATALIE	FACILITY NUMBER: 343618630
	VISIT DATE: 08/03/2023

NARRATIVE

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LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regard to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

To receive important licensed- related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Natalie Timofeyev, Licensee

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Eduardo Barragan	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC809 (FAS) - (06/04)

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