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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002816
Report Date: 03/16/2022
Date Signed: 03/16/2022 11:36:52 AM


Document Has Been Signed on 03/16/2022 11:36 AM - It Cannot Be Edited

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: 14DATE:
03/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Inna KozhinaTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual required inspection today. LPA met with the licensee, Inna Kozhina and 1 helper who have the fingerprint clearance. The purpose of the inspection was explained to her. There were 14 children that included 2 school-age with 1 helper 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,touchless thermometer 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 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. Licensee and 2 helpers had current CPR/First Aid training certificates for review during the inspection. The certificates will expire in 9/2022. Per licensee, there were no guns, no weapons and no pets in the house. Per licensee, there was 1 child on special medication. LPA inspected the place to store the medication in the daycare area. 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. LPA reviewed the children and staff files during the inspection.

This report and notice of site visit were provided to 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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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