414004761-5-20-2021-05-CC-CQUO-C37Q2S-20210520114737

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004761
Report Date: 05/18/2021
Date Signed: 05/20/2021 11:47:42 AM

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:	VOLKONSKA, VIKTORIIA		FACILITY NUMBER:	414004761
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	05/18/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Viktoriia Volkonska		TIME COMPLETED:	11:00 AM

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Due to COVID-19 and DPH guidelines of social distancing, Licensing Program Analyst (LPA) Catrina Quimbo conducted a case management- increase of capacity inspection via FaceTime on May 18,2021 at 10:00am with licensee, Viktoriia Volkonska. The licensee is currently licensed for a Small Family Child Care Home and applied for a Large Family Child Care Home. The licensee obtained a fire clearance and was approved April 16, 2021. Licensee’s current consensus is 6 children, 3 infants and 3 toddlers.

Present at the home during the tele-inspection was licensee, Viktoriia Volkonska, and licensee’s assistant, Olga Kurchenko. Adults working in the home have current finger-print clearance. The facility operates Monday through Friday from 8:00am to 5:00pm.

The licensee is renting the home and resides with her two minor children. The home consists of 3 bedrooms, 2 bathrooms, kitchen, living room #1 (Play Room), living room #2 (Library), dining room, backyard, and garage. The DAY CARE AREAS are living room #1 (Play Room), living room #2 (Library), dining room, bedroom #2 (for napping only), bathroom #1, and gated off areas in backyard. The OFF-LIMITS AREA are bedroom #1, bedroom #3, bathroom #2, kitchen and garage, all inaccessible to children by child safety with locked doors. A health and safety inspection were conducted inside the home.

LPA observed the home to be clean, safe and with working smoke and carbon monoxide detectors and a fully charged fire extinguisher (2A10BC). The license has a fully stocked First Aid kit and thermometer. The home does not have any bodies of water. Garbage cans have tight fitting lids. The home contains a fire place that is properly barricaded and is also covered with sufficient padding. The home has age appropriate toys and equipment available for the children in care. Licensee was reminded baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. Discipline policy was discussed.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

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: VOLKONSKA, VIKTORIIA	FACILITY NUMBER: 414004761
	VISIT DATE: 05/18/2021

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Licensee uses a designated cell phone and is aware the cell phone must stay within the home during day care hours. Per licensee, there are no firearms or weapons in the home. There are no pets in the home. The designated isolation area will be in Bedroom #2, separate from other children in care. Licensee was reminded sick children are to always be supervised until parents pick child up. All hazardous materials and toxins are kept out of reach from children and are not accessible.

Licensee provides food service with breakfast, lunch and dry snacks. Food storage, sanitization, and children’s allergies were discussed. Kitchen is made inaccessible to children in care by child safety with locked doors. Licensee provides sleeping cots, mats, sheets and blankets. Safe sleep regulations, laundering, COVID-19 guidelines and sanitization was discussed.

The licensee completed the Health and Safety Training on October 21, 2017 and CPR and First Aid Training on September 8, 2019. Licensee completed the Mandated Reporter Training on December 11, 2020. Licensee was reminded to renew CPR and First Aid Training every two years.

Licensee is not considering providing Incidental Medical Services (IMS) currently. IMS policy was discussed. For IMS information see Evaluator Manual –regulation interpretations and Procedures for the home. When any IMS is provided, an updated plan of operations for IMS will be submitted to the Department. Licensee displays required documents in the home.

Capacity limits and ratios for a Large Family Day Care have been reviewed with licensee. LPA reminded licensee that assistant must be present.

Prior to approval of capacity increase, licensee must complete the following:

-Completion of EMSA Certified of Lead Poisoning Training

-COVID-19 Self-Assessment
-Proof of COVID-19 postings

Licensee was advised to contact San Bruno Regional Office for concerns or questions. Desk Duty is available M-F, 8:00am to 5:00pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing

This report is public and can be reviewed. A copy of this report will be emailed to licensee. Licensee was advised to acknowledge receipt of report once received.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

LIC809 (FAS) - (06/04)

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