343620088-1-28-2025-03-CC-LHAM-DDCSYF-20250128131730

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343620088
Report Date: 01/28/2025
Date Signed: 01/28/2025 01:17:47 PM

Document Has Been Signed on 01/28/2025 01:17 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:	NESMIYAN, OKSANA		FACILITY NUMBER:	343620088
ADMINISTRATOR/ DIRECTOR:	NESMIYAN, OKSANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 412-9998
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	01/28/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:35 AM
MET WITH:	Oksana Nesmiyan		TIME VISIT/ INSPECTION COMPLETED:	01:25 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 Tuesday, January 28, 2025, at 11:35 AM Licensing Program Analyst (LPA) Lea Habtom met with Licensee, Oksana Nesmiyan, for the purpose of an unannounced annual inspection. Upon arrival, LPA observed licensee supervising 12 preschool children. At 12:05 pm licensee's adult son arrived as the assistant. All individuals subject to criminal background review have obtained a criminal record clearance. Licensee confirmed that there are no new residents or employees since the last inspection. Facility hours of operation are Monday through Friday from 7:00 AM to 11:00 PM. A health and safety evaluation was conducted in all areas accessible to children. Off-limit areas includes: entire upstairs, laundry room and garage. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a functioning smoke detector, carbon monoxide detector, and a full 2A10BC fire extinguisher. The licensee stated there are no weapons or poisons in the home. The backyard is fenced and there are no bodies of water. LPA reviewed children’s files which were observed to be complete. Required postings and the children’s roster were observed. Licensee does not currently have infants enrolled. Licensee last conducted a fire drill on 12/6/2024. Licensee’s CPR/First Aid card expires 4/2026. Licensee’s Mandated Reporter certificate expires 1/8/2026. Licensee understands that trainings must be completed every two years. LPA verified that the annual fees are current. Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. *PAGE 1. REPORT CONTINUES ON LIC809-C*

Mai Lor	TELEPHONE: (916) 263-5728
Lea Habtom	TELEPHONE: (916) 208-2538
	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

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 4

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: NESMIYAN, OKSANA	FACILITY NUMBER: 343620088
	VISIT DATE: 01/28/2025

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
26
27
28
29
30
31
32

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.

Licensee understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Licensee understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report/LIC 624 shall be submitted within 7 days to remain in compliance. Licensee understands that if any structural changes are made to the home; licensing must be notified PRIOR to construction. Licensee understands that if she wants to make any changes to OFF-limit areas to an ON-limit area, she must notify licensing and LPA must do an inspection BEFORE children are allowed in said area. Licensee understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to 3 years.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Page 2. REPORT CONTINUES ON LIC809C

SUPERVISOR'S NAME: Mai Lor	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: NESMIYAN, OKSANA	FACILITY NUMBER: 343620088
	VISIT DATE: 01/28/2025

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
26
27
28
29
30
31
32

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

A notice of site visit was given and must remain posted for 30 days. Appeal rights provided. Based on the inspection, one Type A citation has been issued. Exit interview conducted and report was reviewed with the licensee Oksana Nesmiyan. During the exit interview, the Licensee Oksana Nesmiyan, confirmed that there are no Registered Sex Offenders living in the facility.

Title 22 Deficiency has been cited on the attached LIC 809-D. LPA Lea Habtom informed licensee Oksana Nesmiyan that this report dated January 28, 2025, document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Lea Habtom informed the licensee Oksana Nesmiyan to provide a copy of this licensing report dated January 28, 2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISOR'S NAME: Mai Lor	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 01/28/2025 01:17 PM - It Cannot Be Edited

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: NESMIYAN, OKSANA	FACILITY NUMBER: 343620088
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that there was 12 preschool children being supervised by licensee with no assistant for about 20 minutes which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/29/2025
	Plan of Correction
1 2 3 4	LPA L. Habtom will return to clear plan of correction. LPA explained that licensee must have an assistant at all times if she goes over the small capacity.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Mai Lor	TELEPHONE: (916) 263-5728
Lea Habtom	TELEPHONE: (916) 208-2538
	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

Page: 4 of 4