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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003076
Report Date: 09/10/2019
Date Signed: 09/10/2019 10:45:07 AM

COMPREHENSIVE INSPECTION
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:MYZHALA, OKSANAFACILITY NUMBER:
414003076
ADMINISTRATOR:MYZHALA, OKSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 255-2419
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 9DATE:
09/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Oksana MyzhalaTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual Random inspection. LPA met with Licensee Oksana Myzhala and explained purpose of inspection. Present in home was the Licensee, a helper, and 9 children (preschool age). Licensee is operating within capacity and ratio requirements on this day. Licensee rents the two story home and lives with Licensee's husband and 4 minor children. All adults living or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 7:30am to 6:00pm.

Day Care Areas: First floor only:Living room, dining room, half-bathroom, and backyard. Off Limit Areas: Kitchen, entire second floor, and garage. LPA inspected the day care areas of home with Licensee. LPA observed the home to be clean and in good repair with proper temperature and ventilation. There are no bodies of water on the property. Per the Licensee, there are no firearms or weapons in the home. The fireplace is properly barricaded. There is a variety of age appropriate toys and equipment in the home. Mats are provided for napping and are stored and cleaned properly. Stairs have a child protective gate to prevent children from accessing the second floor. There is also a protective gate to keep the kitchen inaccessible to children. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke and carbon monoxide detectors, a fully charged fire extinguisher, and a working telephone. The backyard has a play structure and outdoor equipment which are age appropriate and in good condition. Foam cushioning is used for soft padding throughout the backyard.

Three children's records reviewed were complete and included immunization records and parents' rights form. Two staff records reviewed were complete. Licensee's Pediatric First Aid/CPR certificate is current and expires May 2021. Last emergency drill was conducted on August 12, 2019. Emergency drills are conducted every six months and are properly logged.

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SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MYZHALA, OKSANA
FACILITY NUMBER: 414003076
VISIT DATE: 09/10/2019
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During inspection,
  • Licensee was given information regarding Safe Sleep Practices.
  • Licensee was reminded 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 1597.662.
  • Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Websites: www.ccld.ca.gov or www.mandatedreporterca.com
  • Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
  • Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

No deficiencies cited today.

This report was reviewed and discussed with Licensee Oksana Myzhala. A copy of report was provided.

This report must be available for public review. Notice of site visit was observed being posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019
LIC809 (FAS) - (06/04)
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