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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000536
Report Date: 02/04/2020
Date Signed: 02/04/2020 11:13:34 AM

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:NIKCHEMNY, VIKTORIYAFACILITY NUMBER:
384000536
ADMINISTRATOR:NIKCHEMNY, VIKTORIYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 665-7208
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:14CENSUS: 9DATE:
02/04/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Viktoriya NikchemnyTIME COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Van met with the licensee, Viktoriya Nikchemny for an unannounced annual inspection. The purpose of the inspection was explained and was granted entry to the home by the licensee. Present today is 9 children (2 infants and 7 preschoolers) with the licensee and 2 helpers. Licensee is operating within capacity requirements on this day. All adults living or working in the home have criminal record clearances on file with the department.

LPA, along with the licensee inspected the day care areas for health and safety hazards. The home is a two level single family house. Licensee owns the house. Day care areas are on the ground level including a nap room, two playrooms, bathroom and the backyard. Off limit areas are the entire second floor and the garage. The home is properly ventilated. There are no pools, spas or other bodies of water on the property. Per the licensee, there are no guns, weapons or pets in the home. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. There is a child-proof gate at the base of the staircase. However, due to today’s repair of the toilet on the second floor, the licensee has temporary removed the gate for workers to access the second floor. The home is equipped with a fully charged fire extinguisher, smoke and carbon monoxide detectors and a working telephone. There is an adequate supply of toys and other learning equipment for the children. Furniture; including pack-n-play, highchairs and chairs are in good condition. Cots are provided to older children for napping. LPA did not observe any walkers, bouncers or any similar items. Licensee understands that smoking is prohibited in family childcare homes. Per licensee, sick children will be separated from the group and will be waited in one of the playrooms for parent to pick up.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536
VISIT DATE: 02/04/2020
NARRATIVE
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LPA reviewed supervision and capacity requirements/expectations. Licensee states that she does not transport children but understands never to leave children unattended in vehicles. Licensee states she understands her capacity options. LPA also reviewed safe sleep for infants and provided informational handout.

At 9:45 am, LPA reviews records of the children and staff. The licensee has a complete and current roster of children in care. At 9:55 am, LPA requests to see licensee’s documentation of the fire drills, licensee stated that fire drill are conducted monthly. However, the licensee said she had tossed away the log of fire drill. At 10:20 am, during the children records review, LPA several children were missing immunization records. Also, the licensee did not have immunization records in file. Licensee and helpers have valid Pediatric First Aid and CPR in file.

Licensee is aware that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety Code 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

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

See 809D for deficiencies that were 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 LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2020
Section Cited

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102417 …Operation of a Family Child Care Home
(g)(9)(A)(1)Each family child care home shall conduct fire drills and disaster drills at least once every six months.
1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. (1.) The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
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This requirement is not met as evidenced by:Based on observation and records reviewed today, Licensee does not fulfil the requirement of conducting and logging fire drill once every six months. This poses a potential health and safety risk to the children in care
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Type B
02/28/2020
Section Cited

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102418 Immunization. (g) Licensee shall document and maintain each child’s immunizations as long as the child is enrolled.
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(1)This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement is not met as evidenced by records reviewed. C2,C3,C4, and C5 did not have complete immunization cards. Not having Immunization card for each child in care presents a potential Health and Safety risk.

Children need updated immunization records. See LIC 811 dated 2/04/20 for a list of children's names.
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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 LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2020
Section Cited

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H&S 1596.7995(a)(1):Staff Immunization: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been...
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immunized against influenza, pertussis, and measles.
Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met evidenced by Licensee, and helpers were not able to provide any documentation for review . This poses a potential health risk to children in care.
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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 LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4