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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004142
Report Date: 05/30/2019
Date Signed: 05/30/2019 02:34:19 PM

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:STRYUK,ANASTASIA R.FACILITY NUMBER:
384004142
ADMINISTRATOR:STRYUK,ANASTASIA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 317-6060
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 12DATE:
05/30/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Anastasia R. StryukTIME COMPLETED:
02:45 PM
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Licensing Program Analyst, LPA Yee conducted a prelicensing inspection today. There are 12 children, licensee, Anastasia Stryuk (aka Anastasia Nikchemny), her mom present today. The facility is licensed for large under Volynsky, Olga & Nikchemny, Anastasia, license number 384001542. Licensee, Olga Volynsky relocated to another location, co-licensee Anastasia said she was not aware of the relocation application and she did not give any consent to close the previous file. Today, LPA did an emergency inspection for this new application. This is a single family home. Current adult residents are Anastasia and her husband only. There are no pets in the home. The home consists of four bedrooms, two full baths, toilet room, kitchen, living room, dining room, garage, and backyard. Daycare areas (lower level only): playroom, kitchenette, playroom #2, nap room and backyard. The remaining areas of the house are off limit. The home is equipped with a smoke detector, carbon monoxide detector, and fire extinguisher. The back yard is under construction and will not be used until the backyard is finished. The facility will send a photo to the licensing office when construction competes. The home is neat, clean, and ventilated properly. The home is free of hazardous materials. LPA did not observe baby walkers, bouncers, or jumpers in the home. First aid and CPR certificate is current until 6/2020. The licensee states the following: There are no guns or weapons in the home. Liability insurance will be maintained. She will provide food. Required immunization is on file. Child Abuse Mandated Reporter Training, AB1207 certificate is on file. LPA reminded Anastasia to renew the certificate once every 2 years. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm. A written IMS plan was obtained today. SIDS "A Child Care Provider's Guide to Safe Sleep" was provided.
Prior to licensure: Fire clearance approval.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
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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