384000468-1-30-2020-05-CC-BVAN-BLBT76-20200130132814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000468
Report Date: 01/30/2020
Date Signed: 01/30/2020 01:29:48 PM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	VILK, MARGARITA		FACILITY NUMBER:	384000468
ADMINISTRATOR:	VILK, MARGARITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 681-9069
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY:	14	CENSUS: 11	DATE:	01/30/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Margarita Vilk		TIME COMPLETED:	01:30 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), Van conducted an unannounced annual inspection and met with Licensee, Margarita Vilk. The purpose of the inspection was explained and granted entry to the home by the licensee. Present, there are 11 children (3 infants and 8 preschoolers) in care with the licensee and two helpers. All adults living or working in the home have a criminal background clearance on file. The licensee lives in a single-family home. Day Care Areas are on the ground level, including a playroom, two nap rooms, a kitchen/dining area and the backyard. Off limit areas are the garage and the whole second-floor level. Days and operation hours are 8:00 am – 6:00 pm, Monday - Friday. Per Licensee, sick children will be separated from the group and will be waiting in the baby nap room for the parent to pick up. LPA and licensee inspected the daycare areas for health and safety hazards. During the inspection, LPA observed the following: The daycare area is clean, orderly, and equipped with age-appropriate toys and equipment for the children. The home has adequate lighting and ventilation. Home has a working telephone, working smoke and carbon monoxide detector, and a fully charged fire extinguisher. First aid supplies are available for children. Per licensee, there are no firearms or weapons in the home. LPA observed no pools, spas, or other bodies of water on the premises. LPA observed licensee had posted all the required forms (i.e., License, Notification of Parent's Rights, Notification of Personal Rights, and Emergency Disaster Plan). Per licensee, fire drills are conducted monthly and documented accordingly, and the last fire drill was performed on 12/17/2019.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VILK, MARGARITA	FACILITY NUMBER: 384000468
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/28/2020 Section Cited	1 2 3 4 5 6 7	102416 Personnel Requirements (c)The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
	8 9 10 11 12 13 14	This requirement was not met, as evidenced by the records reviewed. Licensee and S1 Pediatric FirstAid CPR had expired; this poses a potential health and safety risk to children in care.The licensee states, she will have S2 obtaining verification of immunization or immunity by 2/28/2020. A return visit will be conducted to verify the correction.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VILK, MARGARITA	FACILITY NUMBER: 384000468
	VISIT DATE: 01/30/2020

NARRATIVE

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During the inspection, LPA reviewed the children's records, licensee's records, and helper's records. LPA observed, identification, and emergency information form for every child for proper names and numbers filled. During staff records review, LPA found the following, licensee and all helpers have a record of immunization on file. The Licensee and S1 Pediatric FirstAid and CPR had expired; only S2 has a valid CPR.

LPA discussed the following with the licensee. The licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Also, Licensee was given information regarding 'Safe Sleep' practices, and LPA discussed the Family Child Care Home checklist with the licensee. LPA provided the checklist to the licensee as a reference for future inspection guide.

See LIC 809D for a deficiency that was cited in today’s inspection. A copy of this report was reviewed and provided to the licensee. This report will be kept in the facility file and will be made available for public review upon request. Notice of Site Visit was observed to be posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020

LIC809 (FAS) - (06/04)

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