343623566-5-19-2020-03-CC-TWAN-BPRT2N-20200519142100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623566
Report Date: 05/19/2020
Date Signed: 05/19/2020 02:21:26 PM

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:	KALINOVSKAYA, MARINA		FACILITY NUMBER:	343623566
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/19/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Marina Kalinovskaya		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 Analyst (LPA) Tanya Washington contacted Applicant Marina Kalinovskaya for the purpose of an announced pre-licensing/ change of location tele-inspection. Due to COVID19 pandemic, a tele- inspection is being conducted via Facetime. The applicant was previously licensed at facility #343620559. During today's virtual inspection Applicant's adult sons were also present in the home. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday- Friday from 5 AM to 7 PM. Applicant and her spouse are the home owners and proof of ownership was provided with the application. A health and safety inspection was conducted inside and out. This facility is a two story home which consists of 4 bedrooms, 3 bathrooms, a living room, play room, dining area, kitchen, backyard and garage. The off-limit areas in the home will consist of entire second floor, garage and laundry room. Applicant stated that she plans to use the downstairs bedroom, however it is currently off limits. Applicant understands that prior to use she must contact LPA. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. The fireplace located in the living room is barricaded. Toxic and hazardous items are inaccessible to children and are stored in the off limits laundry room. Sharp knifes are stored on top of the refrigerator, Applicant understands that if she starts storing cleaning compounds in any part of the home accessible to children, those items must be stored out of children's reach. Medication is stored in cabinet located in the hallway across the bathroom on the upper shelf. A functioning smoke and carbon monoxide detector are functioning in the home. A 2A10BC fire extinguisher is stored under the kitchen sink. LPA observed required documents posted in the play room located upon entry. Report continues on LIC809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2020

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: KALINOVSKAYA, MARINA	FACILITY NUMBER: 343623566
	VISIT DATE: 05/19/2020

NARRATIVE

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Preventative Health and current in-person EMSA pediatric CPR and First Aid certification was verified and expires 03/26/2021. Applicant stated there are no weapons in the home. There are no bodies of water on the premises. Applicant was encouraged to maintain supervision at all times. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.

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

This facility evaluation report was reviewed and discussed with the applicant. LIC 311D, records, postings, and reporting requirements were discussed. LPA discussed supervision, personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided to Applicant by email transmission the Safe Sleep in Child Care and the Effects of Lead Exposure brochures. LPA also emailed all required licensing forms.

Effective today, May 19, 2020 - this facility is approved for a small family childcare license that may have a maximum capacity of up to 8 children with no more than 2 infants, with 1 child to be in Transitional Kindergarten or above and 1 child to be at least 6 years of age or older.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2020

LIC809 (FAS) - (06/04)

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