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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004671
Report Date: 11/16/2020
Date Signed: 05/24/2021 07:52:16 AM

Document Has Been Signed on 05/24/2021 07:52 AM - 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:ALPHA KIDS ACADEMY LLCFACILITY NUMBER:
414004671
ADMINISTRATOR:SHTERN, NATELLAFACILITY TYPE:
850
ADDRESS:201 RAVENSWOOD AVENUETELEPHONE:
(415) 999-2208
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/16/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Natella Shtern and Magda BachakashviliTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Glenn Schnell met with Applicant Natella Shtern and Magda Bachakashvili today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting 50 children (ages 2 years to entry into first grade). The program will be located inside a religious facility called First Church of Christ. The facility will operate Monday - Friday; 7:00 AM to 6:00 PM. The designated director/site supervisor for the facility is Viktoriya Beissekova. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: There are seven spaces that will be used for the program and the following square footage was calculated for each room: Main Room (566.948 sq ft.) Room 1 (321.993 sq ft.) , Room 2 (115.158 sq ft)., Room 3-art room off room 2 (143.500 sq ft.), Room 4 (72.187 sq ft.), Room 5-pre-k room (243.058 sq ft.), Room 6 (270.829 sq ft.). Total useable indoor square footage is 1733.673 sq ft divided by 35 sq ft equals 50 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There are cubbies used as storage space for children's personal belongings and mats to be utilized for napping children. Parents will provide a sheet and blanket for their child, bedding will sent home to be laundered weekly. Recommendations during COVID-19 is to launder bedding daily. Cots will be cleaned daily. The indoor space is equipped with a fire extinguisher, smoke alarms and a fire alarm system, there is a separate kitchen area with a microwave and refrigerator where snack food is stored. The program provides two snacks daily and parents will provide lunch. Only disposable products will be used for food service since the facility is not set up to provide adequate sanitization of dishes and utensils. Report continues on the next page.
Ali Zebila
Glenn A Schnell
DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2020
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 4
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: ALPHA KIDS ACADEMY LLC
FACILITY NUMBER: 414004671
VISIT DATE: 11/16/2020
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The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures- staff will talk with the children and use redirection, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements.

The facility will conduct monthly disaster drills and a log will be maintained for review upon request. The final fire inspection of the facility has not been conducted yet.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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: http://www.ada.gov/childqanda.htm

During the pre licensing inspection today the applicants were provided with the COVID-19 self assessment guide. LPA reviewed this guide and required postings with the applicants and requested the guide be completed and returned to LPA as part of completing the application process for licensure. Report continues on next page.
SUPERVISOR'S NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ALPHA KIDS ACADEMY LLC
FACILITY NUMBER: 414004671
VISIT DATE: 11/16/2020
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LPA Schnell will recommend licensure of this facility for a capacity of 50 children once the following is received:

-Approved final fire safety clearance for 50 children
-Updated Original LIC 401
-LIC 503 forms needed for Natella, Magda
-Waiver requesting licensure and use of the outdoor play area that can only accommodate 36 children at a time. Rotation schedule to be submitted with request
-Updated LIC 999
-Clean storage boxes and church items located in some of the rooms to be used for the program. Send pictures as proof of completion.
-Obtain garbage cans with tight fitting lids for rooms to be used for the program
-Proof of having a first aid kit with all required supplies
-Proof that rooms to be used have carbon monoxide detectors
-Pictures showing completion of outdoor space and fencing
-Pictures showing the required facility postings, including COVID-19 postings
-For Viktoriya the following is needed: Proof of Pediatric CPR and First Aid. Proof of updated mandated reporter training. Proof of Immunization for Influenza
-Completion of COVID-19 Self Assessment
-LPA receives a signed copy of this 4 page pre-licensing report

An electronic copy of this three page report was emailed to applicant Natella Shtern on 11/17/20. Applicant was asked to review the report and return a signed copy of the report to LPA Schnell.
SUPERVISOR'S NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: ALPHA KIDS ACADEMY LLC
FACILITY NUMBER: 414004671
VISIT DATE: 11/16/2020
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Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. Medications will be stored in the office area inaccessible to the children or the kitchen where there is a refrigerator located for refrigerated medications. There are 6 toilets and 5 sinks accessible for children's use. There are two bathrooms one located off the main room and another located next to the kitchen. There is a third bathroom in room 1. The bathrooms were observed to be clean and with no health and safety hazards. Total allowable capacity for toilets is and 90 sinks is 75. Sinks accessible to children deliver water that is no warmer than 120 degrees. Children will either have water bottles with water or the program will provide filtered water in a pitcher with cups for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinets or a closet and will be inaccessible to children. Isolation of ill children will be located either in the director’s office and staff bathroom located in a separate building of the church will be used for an ill.

Outdoor: The outdoor area measures 2726.500 sq ft. allowing for a total of 36 children. LPA advised that a waiver will need to be approved for scheduled rotational usage. LPA Schnell needs to receive a request for a waiver and rotation schedule during today's inspection. The outdoor area is to be enclosed by at least a four foot fence, which is still under construction. The area was observed to be under construction. observed to be clean, safe and equipped with toys and equipment for children. Resilient material of rubber mulch will be located on the play area on the side of the building. The front part of the building where the other portion of the playground will be is concrete surface. There will be a pitcher of water and cups to allow children access to drinking water outside, or children will use their own water bottles. Shade for children will be provided by awnings attached to the building. Report continues on next page.
SUPERVISOR'S NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
LIC809 (FAS) - (06/04)
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