414000933-6-30-2023-05-CC-CQUO-CTAS9B-20230630134029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000933
Report Date: 06/30/2023
Date Signed: 06/30/2023 01:40:33 PM

Document Has Been Signed on 06/30/2023 01:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	KOFMAN, NATASHA		FACILITY NUMBER:	414000933
ADMINISTRATOR:	KOFMAN, NATASHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 952-0656
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	14	CENSUS: 8	DATE:	06/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Natasha Kofman and Mark Kofman		TIME COMPLETED:	02:00 PM

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 June 30, 2023 at approximately 11:25am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Natasha Kofman, and licensee's son, A1, and explained the purpose of the inspection. Present during LPA's visit included licensee, A1, and an additional assistant. Licensee lives in the multi-level home with A1. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 8:00am to 5:30pm The DAY CARE AREAS are the living room, bathroom #1, bedroom #1 (napping room), dining area, kitchen, hallway (pass by only to backyard), and half of backyard. The OFF LIMIT AREAS are the entire second level, entire third level, and garden area of backyard. Off limit areas are made inaccessible with child safety gates. LPA inspected day care areas of home with licensee and A1. Licensee operates home as a music, Russian and English immersion program. LPA observed home to be in good repair with proper temperature and ventilation. Home is clean and organized with children's toys properly maintained and appropriately stored. LPA did not observe any accessible poisons or chemicals in the home. Electrical outlets are made inaccessible with child safety locks. Bathroom for children's use was observed to be clean and in proper working condition. Bathroom is equipped with appropriate toileting equipment and appropriate sanitation products. LPA did not observe any poisons, chemicals or hazardous materials in accessible cabinets. Home is equipped with a fully charged fire extinguisher, fire alarm system and a working smoke/carbon monoxide detector. Per A1, there are no weapons or firearms in the home. Entire outdoor area is fully enclosed with an at least 4 ft. high fence. Portion of the backyard that is off limits is a garden area, that has a separate fence. LPA observed outdoor area to be equipped with a variety of outdoor toys and equipment that were in good working condition. Flooring in backyard was observed to have padding. LPA did not observe any pools, spas or bodies of water on the property. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KOFMAN, NATASHA	FACILITY NUMBER: 414000933
	VISIT DATE: 06/30/2023

NARRATIVE

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LPA reviewed 9 children’s records. Children’s files have a record of emergency identification information on file. All staff present have a current CPR/First Aid certification that will expire 07/11/2023. Assistant present also had a record of required immunizations that were made available for review.

Licensee maintains a child care roster that was made available for review. Required licensing documents are properly posted near front entrance of home. Emergency drills are conducted and documented. Last emergency drill was conducted 05/17/2023.

LPA reminded that Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training.

Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

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: www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KOFMAN, NATASHA	FACILITY NUMBER: 414000933
	VISIT DATE: 06/30/2023

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Natasha Kofman.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC809 (FAS) - (06/04)

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