414003076-9-27-2022-05-CC-LGOZ-CJNQVG-20220927123019

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414003076
Report Date: 09/27/2022
Date Signed: 09/27/2022 12:31:08 PM

Document Has Been Signed on 09/27/2022 12:31 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MYZHALA, OKSANA		FACILITY NUMBER:	414003076
ADMINISTRATOR:	MYZHALA, OKSANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 255-2419
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	14	CENSUS: 8	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Oksana Myzhala		TIME COMPLETED:	12:45 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 9/27/2022 at 9:25AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Oksana Myzhala. Purpose of the inspection was explained and was for an unannounced; annual random inspection. Present in facility was the licensee, licensee’s daughter and helper caring for eight children (4 Preschool Age, 4 Infant Age). Adults present have their criminal record clearances on-file. Licensee's home is three bedroom, three bathroom, two level townhouse. Days and hours of operation are Monday- Friday, 8:00- 6:00pm. Day-care area are: First Floor: Living Room (Playroom); Dining Room (Napping Area); Bathroom #1 and Backyard Area. Off-limit area are: First Floor: Garage; Kitchen; Entire Second Floor: Bedroom #1; Bedroom #2; Bedroom #3, Bathroom #2; and Bathroom #3. LPA inspected home with licensee for health and safety hazards. At 9:35AM., the following was observed: Day-care was clean, orderly, with age appropriate playthings available for the children. Accessible furniture, puzzles and books inspected were in good repair. Playroom has child sized tables and chairs for snack and activities. Coat hooks are in entry way for added storage. Fireplace has been barricaded. Area rugs and soft surfaces have been installed for added safety. For napping services, LPA observed napping supplies and infant playpens stored in the facility closet. Licensee has at least one crib available (with tight-fitting sheet) for each infant in care. Bathroom#1 had adequate supplies for handwashing. Fixtures tested were in operating condition. Accessible outlets and trash bins are covered. Facility was the proper temperature, with ventilation and lighting. Home had functioning telephone; smoke detector; carbon monoxide detector; and one (fully charged) fire extinguisher, 2A:10BC. At 9:50AM., LPA inspected the outdoor play area. The outdoor space is completely enclosed with shading available. Outside playthings were in good repair. Home does not any pools, fishponds, or bodies of water on the premises. At 9:55AM., Based on observations, LPA confirmed fence in backyard area is leaning over. Advisory Note: Technical Violation (LIC9102TV) was issued during inspection. (REFER TO 809C FOR CONT)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MYZHALA, OKSANA	FACILITY NUMBER: 414003076
	VISIT DATE: 09/27/2022

NARRATIVE

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At 10:20AM, LPA reviewed the facility and children’s records. Children's records were reviewed and included the Identification of Emergency Information (LIC700); Immunization Records; and Notification of Parent’s Rights (LIC995A) and Infant Sleeping Plan for qualifying infants in care.

LPA reminded licensee to maintain documentation of napping conditions for each 15- minute check, for each infant in care.

Facility records were reviewed and include Criminal Record Statement (LIC508), Proof of Required Immunization, and Notice of Employee Rights (LIC9052).

LPA reminded licensee to ensure all staff have completed the required mandated reporter training (AB1207).

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 05/2023. Licensee is conducting emergency disaster drills; with last drill completed on 6/5/2022, and properly logged.

LPA observed childcare license properly posted. LPA reminded licensee to ensure all required posting are posted in visible location for families. Posting must include the: Notification Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A). Advisory Note: Technical Assistance (LIC9102TA) was issued during inspection.

Per licensee, isolation of ill children is in playroom.

Per licensee, facility provides all lunch and snack for children in care. LPA reminded licensee to ensure all children’s food containers brought by families is properly labeled. Per licensee, her home does not have any firearms or weapons.

Licensee was reminded that all adults 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.

(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MYZHALA, OKSANA	FACILITY NUMBER: 414003076
	VISIT DATE: 09/27/2022

NARRATIVE

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

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Health and Safety Code of Regulations. Exit interview and report was discussed with Licensee, Oksana Myzhala and signature of this form acknowledges receipt of these documents.

Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

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