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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620137
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:54:40 PM


Document Has Been Signed on 07/02/2024 02:54 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:KOROL, OLGAFACILITY NUMBER:
343620137
ADMINISTRATOR:KOROL, OLGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 677-6871
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:14CENSUS: 15DATE:
07/02/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Olga KorolTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Loraine Perez met with Licensee Olga Korol, for an unannounced inspection. During today’s visit there was a census of four school age, nine preschool and two infants for a total of 15 children in care. Present today was Licensee, adult son, and teenage son. Licensee’s teenage son was assisting in providing care to the children and assisted with some language translation. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 6 AM to 6 PM.

A health and safety inspection was conducted in the areas accessible to children. Off limit areas include whole upstairs, garage, fenced left side of yard. Licensee understands that children may never enter off-limits areas. LPA observed 15 children in care which is more than the capacity aloud for a Large Family Child Care Home. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a 2A10BC fire extinguisher within the home. LPA observed the home was safe, orderly, and free of hazards. LPA observed a variety of age-appropriate toys. Licensee stated there are no firearms or bodies of water on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock. LPA observed all required postings. LPA reviewed records of children’s files and staff files, all of which contained the required documentation. Licensee has current EMSA-approved pediatric CPR/First Aid certificate which expires 05/2025. Licensee is exempt from Mandated Reporter Training due to language barrier. Licensee understands both CPR and Mandated Reporter training must be completed every two years.

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.

SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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Document Has Been Signed on 07/02/2024 02:54 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: KOROL, OLGA
FACILITY NUMBER: 343620137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, It was observed there were blankets and pillows in portable play yards where children were sleeping, which poses an immediate health, and safety risk to persons in care. When LPA brought this to the attention of the Licensee, the Licensee immediately removed the blankets and pillows from the portable play yards bringing the Licnesee back into compliance.
POC Due Date: 07/03/2024
Plan of Correction
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Licensee stated she will not use blankets or pillows in the portable play yards any more.
Type A
Section Cited
CCR
102416.5(d)(2)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by accepting a child who does not attend regularly at the request of a parent, giving the Licensee 15 children in care, which poses an immediate health, and safety risk to persons in care. Two children were picked up during today's visit bringing the Licensee back into compliance.
POC Due Date: 07/03/2024
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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: KOROL, OLGA
FACILITY NUMBER: 343620137
VISIT DATE: 07/02/2024
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LPA reviewed with Licensee the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

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/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.



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.

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. 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.
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 3 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: KOROL, OLGA
FACILITY NUMBER: 343620137
VISIT DATE: 07/02/2024
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Title 22 deficiencies are being cited based on today's inspection and are recorded on LIC 809 D.
LPA Loraine Perez informed Licensee Olga Korol that this report dated 07/02/2024 documents two Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety of children in care.
Also, LPA Loraine Perez informed the Licensee Olga Korol to provide a copy of this licensing report dated 07/02/2024 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.
Exit interview conducted and report was reviewed with Licensee Olga Korol. Notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4