343623884-4-7-2021-03-CC-RPIS-BZUP5R-20210407110111

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623884
Report Date: 04/06/2021
Date Signed: 04/07/2021 11:01:29 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:	LEBEDEVA, NATALIYA		FACILITY NUMBER:	343623884
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/06/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nataliya Lebedeva		TIME COMPLETED:	12:15 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

NOTE: Due to COVID19 pandemic and DPH guidelines on physical distancing, a Tele-visit via ZOOM is being conducted. On Tuesday, April 6, 2021, at approximately 10:30 AM, Licensing Program Analyst (LPA) Rosie Pitts met with Licensee Nataliya Lebedeva via ZOOM for the purpose of conducting a Change of Location/ Prelicensing tele-inspection. Applicant was previously licensed under Facility #343622951

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee plans to operate from 6AM to 6PM and occasionally allowing over-night care.

A health and safety inspection was conducted inside and out. The single story home has an unfenced front yard, 4 bedrooms, 2 bathrooms, a living room, dining room, kitchen, garage, sunroom, gated side yard, and fenced backyard that contains a locked shed. The OFF LIMITS areas include: garage, side yard, children's bedroom, and master bedroom and bath on the left. Licensee understands that Off-limit areas will remain inaccessible to children by closed doors and/or supervision. The fireplace in the living room is appropriately barricaded to prevent access by children and Licensee stated that it will not be in use during daycare hours. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors, a 3A40BC fire extinguisher, as well as a first aid kit were observed in the home. Preventative Health, current pediatric CPR and first aid training was verified. Per applicant, there are no weapons in the home. There are no bodies of water on the premises. Licensee was encouraged to maintain supervision at all times. Zero Tolerance and immediate Civil Penalty regulation deficiencies were reviewed. Criminal background clearances were discussed. Licensee understands that any alterations to the existing grounds must be reported to licensing prior to construction.

Report continued on 809-C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021

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 2

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: LEBEDEVA, NATALIYA	FACILITY NUMBER: 343623884
	VISIT DATE: 04/06/2021

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

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 licensee. LPA discussed and provided COVID-19 safety guidelines. Records, postings and reporting requirements were discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

As of today, April 6, 2021 facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only; or up to 8 children with no more than 2 infants, with 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

In lieu of Licensee's signature, LPA Pitts is e-mailing the report and Licensee will respond via email as verification of receipt.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2