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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002816
Report Date: 02/24/2020
Date Signed: 02/24/2020 10:41:19 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:KOZHINA, INNAFACILITY NUMBER:
384002816
ADMINISTRATOR:KOZHINA, INNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 335-2319
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:14CENSUS: 12DATE:
02/24/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Inna Kozhina TIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Mok conducted an unannounced 1 year required inspection today. LPA met with the licensee, Inna Kozhina and 2 helpers who have the fingerprint clearance. The purpose of the inspection was explained to her. There were 12 children that included 1 infant with 2 helpers present. The operation hours of the facility are Monday to Friday from 7:30am to 6:00Pm. The main entrance of the daycare is next to the garage door. Licensee owns this 2 stories single family house. Licensee lives in the house by herself. There are two bedrooms, 1 bath, a living room, dining/Kitchen area on the upper level; the lower level has two bedroom, one bath, a living room, garage and backyard. The daycare areas are the entire lower level that includes 2 bedrooms, 1 bathroom, living room, and backyard. The off-limit areas are the entire upper level and a garage. LPA toured and inspected the facility for health and safety hazard. The facility was clean and in order. Temperature and lighting were adequate. All toxins and harmful objects were either locked or made inaccessible to the children. Right amount of cubbies were available for the children to store their own belonging by the main entrance. There were plenty of the age-appropriate toys, books, learning material/equipment and children's furniture available for children indoor, All the equipment and furniture were in good condition. There were a fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detectors, and first aid supplies available in the daycare. All electrical outlets were covered. All the lower drawers and cabinets were either latched or free of harmful in its. Carpets were used as the soft cushioning on the daycare floor to prevent injury. Cots and play pens were used for napping. Children's bathroom was clean. The lower bathroom sink cabinet was free of harmful objects. The outdoor play area was completely fenced. Turf was installed to the entire outdoor area as the soft cushioning to prevent injury. There were plenty of the outdoor toys, ride-on-toys, play house, and slide available for children. Licensee provides breakfast, AM/PM snacks, lunch, and dinner to the daycare children. Fire drill is conducted monthly. The latest drill was conducted on 1/15/2020. Licensee and 2 helpers had current CPR/First Aid training certificates for review during the inspection. The certificates will expire in 6/2020. Per licensee, there were no guns, no weapons and no pets in the house. Per licensee, there was 1 child on special medication. 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 facilities and the ADA, available at: http://www.ada.gov/childqanda.htm. All the required postings were posted. Children files and roster were reviewed during the inspection. LPA also obtained a copy of the current roster from licensee during the inspection. The licensee and 2 helpers already completed the required Child Abuse Mandated Reporter Training (AB1207). The certificates were reviewed during the inspection.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020
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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