343622925-2-9-2023-03-CC-JVEO-CNVTPV-20230209135458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622925
Report Date: 02/09/2023
Date Signed: 02/09/2023 01:56:31 PM

Document Has Been Signed on 02/09/2023 01:56 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:	MARTYNOV, TATYANA AND LOBKOV, YEKATERINA		FACILITY NUMBER:	343622925
ADMINISTRATOR:	MARTYNOV, TATYANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 223-3697
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	14	CENSUS: 7	DATE:	02/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Tatyana Martynov, Yekaterina Lobkov		TIME COMPLETED:	02:00 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	Licensing Program Analysts Erwina Pascual-Golamco and Jennifer Velasco (LPAs) conducted an unannounced annual inspection and met with Licensee Tatayana Martynov (L1) and Licensee Yakaterina "Katya" Lobkov (L2). LPAs observed seven children in care with L1. Facility hours of operation are Monday through Friday 6:00 AM to 6:00 PM. Annual facility fees are current. L1 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. Off limit areas include: Right side bedrooms, laundry room, backyard, and two storage sheds. L1 acknowledged that children may never enter these off-limit areas. LPAs conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPAs observed required documents were posted where visible to parents. LPAs observed that the cleaning compounds, medications, and sharp objects were kept inaccessible to children. LPAs observed a 2A-10-BC fire extinguisher. LPAs observed the smoke and carbon monoxide detectors are functioning properly. The facility has toys and equipment safe for children to use. The backyard is fenced. LPAs observed there were no bodies of water. L1 stated there are no firearms in the home. LPAs observed a current children's roster and a fire drill log but no safe sleep log. LPAs reviewed children’s files and observed that the required documentation was not present in each child's file. LPAs provided L2 with an LIC 311D and provided technical assistance. LPAs observed the CPR/First Aid certificates were current. LPAs observed a current Mandated Reporter certificate for L1 and L2. L1 was reminded the Child Care portion must be completed every two years. LPAs reviewed staff and facility files and observed the required documentation.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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: MARTYNOV, TATYANA AND LOBKOV, YEKATERINA	FACILITY NUMBER: 343622925
	VISIT DATE: 02/09/2023

NARRATIVE

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LPAs discussed with L1 and L2 the safe sleep regulations and Child Care Licensing Safe Sleep web pagehttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAS also informed L1 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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. LPAs discussed current COVID guidelines with L1 and provided technical assistance.

LPAs provided the Department’s website WWW.CCLD.CA.GOV, so L1 can obtain updated licensing information, new regulations and access forms. LPAs advised L1 of their responsibility to stay current by reviewing PINs on the website.

Upon arrival, LPAs observed an infant swaddled and sleeping in a swing. LPAs provided technical assistance and advised L2 to remove the sleeping infant from the swing and remove the blanket used to swaddle the infant. There was no sleep plan for the infant under twelve months and no sleep log for three infants under two years old.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, deficiencies are noted on the following report. See LIC 809-D. There are two Type A deficiencies, hence AB 633 Notification applies. Upon receipt the facility must post this report along with the notice of site visit for 30 days for parents to view. Facility staff must inform the parents/guardians of children in care at the facility and inform the parents/guardians of children newly enrolled in the facility for 12 months and document this via form LIC 9224 Acknowledgement of Receipt of Licensing Reports. Facility staff must retain the signed LIC 9224 forms in each child's file through the child's enrollment and for a period of at least three years after the child is no longer enrolled in the facility.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/09/2023 01:56 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MARTYNOV, TATYANA AND LOBKOV, YEKATERINA	FACILITY NUMBER: 343622925
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102425(f)

(f) An infant shall not be swaddled while in care. This requirement is not met as evidenced by: LPAs' observation upon arrival of an infant swaddled in a blanket.
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in one out of one sleeping infant, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/10/2023
	Plan of Correction
1 2 3 4	L2 stated she will not swaddle any infant during hours of care and will instead place the infant on their back in a crib or play yard with no blankets or other loose articles. L2 stated she will provide to LPA on or before POC due date a written plan for doing so. LPA email: jennifer.velasco@dss.ca.gov

Type A

Section Cited

CCR

102425(i)

If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. This requirement is not met as evidenced by: LPAs' observation of an infant asleep in a swing.
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in one out of one sleeping infant in car, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/10/2023
	Plan of Correction
1 2 3 4	L2 stated she will no longer allow an infant to stay in a swing asleep but will move the infant to the crib or play yard as soon as possible. L2 stated she will provide to LPA on or before POC due date a written plan for doing so. LPA email: jennifer.velasco@dss.ca.gov

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: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/09/2023 01:56 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MARTYNOV, TATYANA AND LOBKOV, YEKATERINA	FACILITY NUMBER: 343622925
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by: LPAs' observation that six of seven children in care had no immunization records and no blue card. One child had immunization records but a blank blue card.
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in seven out of seven children, which poses/posed a potential health, safety or personal rigths to persons in care.
	POC Due Date: 03/03/2023
	Plan of Correction
1 2 3 4	L2 stated she will obtain immunization records and complete blue cards (CDPH 286) for all children in care. L2 stated she will provide evidence of this to LPA via email by POC due date. L2 stated she will obtain immunization records and complete blue cards for all children enrolled in the future. LPA email: jennifer.velasco@dss.ca.gov

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

(j) The provider shall supervise infants while they are sleeping ... (2) The provider shall check and document the following: (D) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: a. Date. b. Infant’s name. c. Time of each 15-minute check. This requirement is not met as evidenced by: .
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in three out of three infants. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/03/2023
	Plan of Correction
1 2 3 4	L2 stated she will begin using safe sleep logs for all infants in care up until they are two years old. L2 stated she will provide evidence of this to LPA via email on or before the POC due date. LPA email: jennifer.velasco@dss.ca.gov

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: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

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