376100822-8-9-2021-51-CC-SSIO-C5QPNG-20210809112755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100822
Report Date: 08/09/2021
Date Signed: 08/09/2021 11:28:48 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:	YAROSHENKO, HALYNA FAMILY CHILD CARE		FACILITY NUMBER:	376100822
ADMINISTRATOR:	HALYNA YAROSHENKO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 922-2631
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92128
CAPACITY:	14	CENSUS: 0	DATE:	08/09/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Halyna Yaroshenko		TIME COMPLETED:	11:35 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	On 08/09/2021 at 9:35am, Licensing Program Analyst (LPA) Selina Siao conducted an announced change of location Pre-Licensing with the applicant. The 3 bedroom 2.5 bath home was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 3A40BC and an operating smoke and carbon monoxide detector. All hazardous items were latched/locked and secured out of reach of children. Applicant stated that there are no bodies of water or weapons in the home. Applicant's EMSA approved CPR and First Aid cards are current due to expire on 12/12/2021 and applicant completed the 8 hours preventative health practice course on 03/08/2020. Applicant has enrolled in the lead poisoning prevention course and is scheduled to take the course on 08/11/2021. Applicant completed the online mandated child abuse training on 09/06/2020 and shall renew the training every two years. A review of staff records on this date indicates that applicant and her adult son Serhii Yaroshenko are the current adult residents in the home and have the required TB and background clearances. Applicant has the required MMR and TDAP immunizations. Applicant has obtained landlord consent to care for up to 14 children and provided a copy of her rental agreement to show that she has control of the property. Applicant will be using the following areas for childcare: front living room, back living room, dining area, laundry room, 1/2 bath located downstairs. Off limit areas includes garage and all of upstairs and there are safety gates and door latches to prevent children's access. The fire place has a safety latch to prevent children from opening the glass door. The home has ample toys and equipment available for children. The children will be playing in the fenced backyard and supervision is required when children are outside. There is a fountain in the front yard and applicant put some potting soil inside the fountain to prevent standing bodies of water.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

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: YAROSHENKO, HALYNA FAMILY CHILD CARE	FACILITY NUMBER: 376100822
	VISIT DATE: 08/09/2021

NARRATIVE

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LPA discussed the following information to applicant: children’s records, child abuse, unusual incident reporting, immunization, adults living or working in the home and associated civil penalties, shaken baby syndrome, SIDS, car seat law, healthy beverage and heat related illness information was provided to applicant. Applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

Applicant shall comply with all regulations and laws governing family child care homes and be financially secure to operate a family child care home for children. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

LPA discussed California Megan's Law with applicant: www.meganslaw.ca.gov. Applicant was advised to register to obtain childcare updates online at www.ccld.ca.gov (Received Important Updates).

A copy of an updated facility roster was obtained today. Fire clearance for a large license was granted on 07/26/2021. No correction is needed a provisional license (valid for 90 days) will be granted effective today. Applicant shall submit an Incidental Medical Service plan to LPA within 14 days as she stated that one of her day care child has an Epi Pen.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

LIC809 (FAS) - (06/04)

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