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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004142
Report Date: 10/04/2019
Date Signed: 10/04/2019 12:16:36 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:
10/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Anastasia R. StryukTIME COMPLETED:
12:30 PM
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2, Licensing Program Analyst, LPA Yee conducted an annual inspection today. There are 12 children, licensee, Anastasia Stryuk (aka Anastasia Nikchemny), her mom, two helpers present today. Another child was present with parents touring the facility (not part of the ratio). Anastasia's mom left during the inspection. The purpose of the inspection was explained. Residents at the facility are Anastasia and her husband only. Daycare areas (lower level only): playroom, kitchenette, playroom #2, nap room and backyard. The remaining areas of the house are off-limits. The home is equipped with a smoke detector, carbon monoxide detector, and fire extinguisher. The home is ventilated properly. LPA observed one infant bouncer inside the playpen. LPA pointed it out. The licensee said they don't use it and remove it immediately. First aid and CPR certificate are current until 6/2020, the helper has current CPR & 1st aid until 8/2020. Required immunization is on file for the licensee. Helpers' immunization is unable to review. LPA advised licensee to keep helpers immunization on file. Child Abuse Mandated Reporter Training, AB1207 certificate is on file for the licensee. However, helpers AB1207 certificate is unable to verify. LPA reminded Anastasia to renew the certificate once every 2 years and helpers need to take Child Abuse Mandated Reporter Training and keep the certificate on file. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/. The children's roster was reviewed. SIDS "A Child Care Provider's Guide to Safe Sleep" was provided.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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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