384002057-12-17-2019-05-CC-WLYY-BJXQNS-20191217111935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002057
Report Date: 12/17/2019
Date Signed: 12/17/2019 11:19:47 AM

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:	BERENSHTEYN, GALINA		FACILITY NUMBER:	384002057
ADMINISTRATOR:	BERENSHTEYN, GALINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 566-1147
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY:	14	CENSUS: 9	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Maria Nefedova		TIME COMPLETED:	11:30 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 December 17, 2019 at approximately 9:00am, Licensing Program Analyst (LPA) Winnie Ly conducted an annual unannounced visit to this family child care home and met with Assistant Maria Nefedova. Purpose of visit was explained. Present during the visit were 9 children and 2 assistants. Per Assistant, Licensee is on Christmas vacation. Licensee rents this two story single family house. There are 1 bedrooms and 1 bath downstairs; the living room, open kitchen dining area and a full sized bathroom are on the second floor. Licensee also use the yard between the two houses for children. House #1664 is the front house and the day care is in the back, there is a yard between the two houses. Day Care Areas on the downstair level included cubby room where children are being greeted and store their personal belonging. Upstair level included the living room as a play area, an open kitchen and dining, a full sized bathroom. Off Limit Areas: downstair level, the bedroom and a bathroom. LPA observed the home is clean orderly and properly ventilated. LPA also observed a 2A10BC Fire extinguisher, operable smoke detectors and carbon monoxide. There are no Fireplace or bodies of water in the home. Electrical outlets have child protective covers in place making them inaccessible to children. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. Kitchen/Bathroom cabinets/drawers have child protective locks in place making all sharp objects or toxic house hold items inaccessible to children. First aid supplies are available for children. Facility conducts fire drills/earthquake drills on July 09, 2019 and was properly logged. If there was an ill child, staff would separate the child from the group while waiting for a parent to pick them up. Disciplinary policy was discussed with Assistant today. Home has age appropriate toys and equipment available for the children in care. LPA reviewed children's files today found files are up to date. All required posting documents are posted and visible.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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 3

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: BERENSHTEYN, GALINA	FACILITY NUMBER: 384002057
	VISIT DATE: 12/17/2019

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

At approximately 9:45am, LPA reviewed staff files and found Licensee's CPR and First Aid information was not available for review. This poses a potential heath and safety risk to the children in care. Type B violation issued today.

This family child care home does not provide Incidental medical Services to children in care. 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.

Licensee was also 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. All staff have proof of Immunization.

LPA discussed Child Abuse Mandated Reporter Training AB1207 with Licensee. As of January 1, 2018 all staff will be required to complete Child Abuse Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Type B violation was being cited based on LPA Winnie Ly’s review of staff files in accordance with the California Code of Regulations, Title 22, see LIC 809D.

An exit interview was conducted and Plans of Corrections (POC) were developed and reviewed with Assistant. A copy of this report and appeal rights were discussed and left with Assistant whose signature on this form confirm receipt of these reports.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: BERENSHTEYN, GALINA	FACILITY NUMBER: 384002057
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/31/2019 Section Cited	1 2 3 4 5 6 7	102416(c) Personnel Requirements. 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. This requirement is not met evidenced by:
	8 9 10 11 12 13 14	Based on LPA reviewed of staff record, Licensee's CPR/First Aid information was not available to be reviewed.	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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3