376100179-12-6-2019-51-CC-RGOU-BJLQJS-20191206111313

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100179
Report Date: 12/06/2019
Date Signed: 12/06/2019 11:13:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	TROFIMOV, LARA FAMILY CHILD CARE		FACILITY NUMBER:	376100179
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	12/06/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Lara Trofimov		TIME COMPLETED:	11:20 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 Analyst (LPA) Rajani Goudreau conducted an announced Pre-Licensing inspection. Upon arrival, LPA met with applicant, Lara Trofimov. Also, present in the home at time of visit one child in care. This two story, 3 bedroom and three bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Applicant plans to operate from Monday through Friday from 7:30am to 5:30pm. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. Children’s toys and play equipment are safe and age appropriate. There are no bodies of water observed by LPA during inspection. There are no firearms or other weapons in the home, per applicant. Pediatric CPR and First Aid certifications expire on 02/23/21. Preventative Health Practices course was completed on 11/24/19. Gas fireplace located in living room is screened with gas turned off. Applicant indicated fireplace is not used. Stairs are securely fenced. Primary telephone is a cell which is operational. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant has provided proof of control of property by a rental agreement. Landlord consent on file. Applicant states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. Applicant has met immunization requirement per SB792. Applicant is exempt from the AB1207 Mandated Reporter Training as applicant’s primary language is not English. Applicant will use the following areas for child care: Living room, dining room, kitchen, bathroom located on first story of home and backyard. Off limit areas of the home include: garage, laundry room, and entire second story of home (two bedrooms, bathroom, master bedroom, master bathroom). Off limit areas of the home are made securely inaccessible. LPA discussed and provided applicant/or Licensee with the following: information on SIDS, shaken baby syndrome, lead poisoning effects brochure, Heart and Nutrition Months hand out, insurance, child abuse reporting, mandated reporter requirements, community resources, children’s records/facility records/required postings-LIC911D, immunization requirements, unusual incident report-LIC624B, roster requirements-LIC9040, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), emergency drill log example, and the YMCA Resource Center. See LIC809-C continuation page...

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TROFIMOV, LARA FAMILY CHILD CARE	FACILITY NUMBER: 376100179
	VISIT DATE: 12/06/2019

NARRATIVE

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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 provided 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.

LPA discussed California Megan's Law and provided Applicant with the following website: www.meganslaw.ca.gov. LPA informed applicant in order to access CCLD-Childcare regulations, quarterly updates, licensing forms, pay annual fee to visit the following website: http://ccld.ca.gov. LPA discussed and provided applicant with the following: Child Care Advocates - (916) 654-1541 and email address childcareadvocatesprogram@dss.ca.gov. In addition, for common questions or questions regarding licensing requirements to contact Child Care Licensing duty line at 619-767-2248.

LPA discussed the following with applicant: maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.

The facility is ready to be licensed after final file review. An exit interview was conducted with applicant. After final file review, License will be mailed to applicant. LPA informed Licensee upon receipt of the license, the Applicant shall post it in a prominent place.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

LIC809 (FAS) - (06/04)

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