343622925-2-21-2020-03-CC-KFEA-BLZQGB-20200221110916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622925
Report Date: 02/21/2020
Date Signed: 02/21/2020 11:09:24 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:	MARTYNOV, TATYANA		FACILITY NUMBER:	343622925
ADMINISTRATOR:	MARTYNOV, TATYANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 223-3697
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	14	CENSUS: 4	DATE:	02/21/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tatyana Martynov		TIME COMPLETED:	11:30 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	Licensing Program Analysts (LPAs) Kelly Ferrara and Tanya Washington met with Licensee Tatyana Martynov for an unannounced random annual inspection of her large family child care home. Hours of operation are Monday through Friday, providing overnight care. LPAs advised that children cannot exceed 24 hours in care. LPAs discussed annual fees with the Licensee. All adults who live and work in the home are fingerprint cleared. There were four children present at the time of inspection with the Licensee. Licensee understands she must revert back to a small license when no assistants are present. A health and safety inspection was conducted in all areas accessible to children. During the inspection, LPAs observed medication was on a low shelf in the kitchen and hallway and therefore accessible to children in care. LPAs advised the Licensee to move the medications. Licensee requested to make changes to off limit/on limit areas and wants to make the master bedroom on limits for children to nap. Off limit areas now include: Right side bedrooms, laundry room, backyard, and two storage sheds. LPAs advised Licensee that the license will be updated and she must post the new license. LPAs observed a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors that meet regulations. LPAs observed a first aid kit, current children's roster, and fire drill log with the last drill conducted in January 2020 . LPAs observed all the required Licensing documentation was posted including Parent's Rights, Emergency Disaster Plan, facility sketch, and the license. Knives and chemicals were all stored inaccessible to children. LPAs did not observe any bodies of water on the premises. Licensee has firearms that are stored according to regulations. LPAs conducted a staff and children's file review. The Licensee and assistants have the required Licensing documents and proof of immunizations. Licensee is exempt from the Mandated Reporter certification due to English is her second language. LPAs observed that all of the required documentation was present in each child's file.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: MARTYNOV, TATYANA	FACILITY NUMBER: 343622925
	VISIT DATE: 02/21/2020

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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 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.

Effects of Lead Exposure and Safe Sleep brochures were given to the Licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. The facility evaluation report was reviewed and discussed and a copy of this report will remain on file for a period of 3 years for public review upon request. Notice of site visit was provided and it must remain posted for 30 days for parental review.

There was one Type A citation issued based on today's inspection. Upon receipt, Licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: MARTYNOV, TATYANA	FACILITY NUMBER: 343622925
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/24/2020 Section Cited	1 2 3 4 5 6 7	Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by: LPAs observed various types of medication on the kitchen counter
	8 9 10 11 12 13 14	and hallway counter. This is an immediate health and safety risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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