414002861-2-15-2023-05-CC-CQUO-CP3UCD-20230215142742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002861
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:28:26 PM

Document Has Been Signed on 02/15/2023 02:28 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MEZHERITSKIY, OLENA		FACILITY NUMBER:	414002861
ADMINISTRATOR:	MEZHERITSKIY, OLENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 342-8047
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	14	CENSUS: 2	DATE:	02/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Olena Mezheritskiy		TIME COMPLETED:	03:00 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 February 15, 2023 at approximately 1:10pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Olena Mezheritskiy, and explained the purpose of the inspection. Present during LPA's visit included licensee and 2 enrolled children (2 infants). Licensee is operating within capacity limits and ratio during LPA's visit. Hours of operation are Monday to Friday from 8:00am to 5:00pm. Licensee lives in the multi-level home with their spouse and minor children. Entrance to the day care is through side gate located on the right side of the home. The DAY CARE AREAS are located on the ground level of the home only that includes playroom (main classroom), bedroom #1 (nap room), serving area, bathroom #1, and backyard. The OFF LIMIT AREAS are the garage and entire second level of the home. Off limit areas are made inaccessible with child safety door handles and/or child safety gates. LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home that were in good condition. LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers and/or blocked by furniture. LPA also observed sharp edges on shelves to be properly padded and covered. 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. All poisons, chemicals and hazardous materials were stored behind child safety locked cabinets. Home is equipped with multiple first aid kits, multiple fully charged fire extinguishers, and smoke and carbon monoxide detector. Per licensee, there are no weapons or firearms in the home. (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: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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

FACILITY NAME: MEZHERITSKIY, OLENA	FACILITY NUMBER: 414002861
	VISIT DATE: 02/15/2023

NARRATIVE

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Entire backyard is enclosed with an at least 5 ft. high fence. Outdoor area is equipped with age appropriate toys and materials that were observed to be in good condition. Flooring in outdoor area was observed to have resilient padding. LPA did not observe any pools, spas or bodes of water on the property.

LPA reviewed two children's records. Children's files were complete and have a record of emergency identification information on file. LPA reviewed licensee's file which was also complete. Licensee has proof of required immunizations that were made available for review. Licensee's CPR/First Aid certification is current and will expire 08/2023. Licensee's Mandated Reporter training certification is also current and will expire 08/2024.

Licensee has licensing documentation properly posted and available for review. Last emergency drill was conducted 01/12/2023. Emergency drills are conducted and are properly logged.

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: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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

FACILITY NAME: MEZHERITSKIY, OLENA	FACILITY NUMBER: 414002861
	VISIT DATE: 02/15/2023

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, Olena Mezheritskiy.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC809 (FAS) - (06/04)

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