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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004840
Report Date: 10/11/2021
Date Signed: 10/11/2021 12:14:29 PM

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:OSTROVSKA, OKSANAFACILITY NUMBER:
414004840
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
10/11/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Applicant, Oksana Ostrovska and H1, Anna ToporovaTIME COMPLETED:
12:15 PM
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On October 11, 2021 at 9:00am, Licensing Program Analyst (LPA), Catrina Quimbo, conducted a scheduled, pre-licensing inspection. LPA met with applicant, Oksana Ostrovska, and applicant’s helper, H1. Applicant applied for a large Family Child Care Home on 09/09/2021. Present in the home was applicant and H1. Applicant rents the home. LPA, applicant and H1 conducted a health and safety inspection inside the home.

All adults living or working in the home have criminal record clearances on file. Hours of operation are from Monday to Friday, 8:00am to 6:00pm. Applicant plans to care for children 2 years to 6 years old. The home is a one level, single family home, which consists of four bedrooms, two bathrooms, living room, kitchen, dining area, backyard, front yard and garage. The DAY CARE AREAS are the living room, kitchen, dining area, bathroom #1, bedroom # 3 (activity room), bedroom #4 (napping room), and backyard. The OFF-LIMITS AREAS are bedroom #1, bedroom #2, bathroom #2, front yard and garage. Applicant is aware OFF-LIMITS areas are not to be used without prior approval from department. LPA observed the home to be clean, safe and with a working smoke detector, fully charged fire extinguisher (2A10BC), and fully equipped First Aid Kit. The home does contain a fireplace, that is properly barricaded. Applicant uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours.



The home has age appropriate toys and equipment available for the children in care. All electrical outlets children have access to have child safety covers and/or are blocked by furniture. Garbage cans have tight fitting lids. All harmful and sharp objects are made inaccessible from children in care. Per applicant, there are no firearms, weapons or pets in the home. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. The backyard is enclosed with an at least 5 ft. fence and equipped with materials in good working condition. There are no bodies of water or additional living spaces. Applicant will provide small beds and sheets for napping children in care.
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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
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 3
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: OSTROVSKA, OKSANA
FACILITY NUMBER: 414004840
VISIT DATE: 10/11/2021
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LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Safe sleep regulations, laundering, COVID-19 guidelines and sanitization were discussed. LPA reminded applicant and H1 emergency drills are to be conducted and documented once every six months. Applicant’s discipline policy will be redirection.
The designated isolation area will be in the living room, separate from other children in care. All hazardous materials and toxins are kept out of reach from children and are not accessible. Applicant will provide food service. Food storage, preparation and sanitization was discussed.

This facility plans to provide Incidental Medical Services-IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was the 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 and Child Care Centers and the ADA, available at : http:/www.ada.gov/childqanda.htm

The applicant completed the Health and Safety training on August 19, 2021 and First Aid Training on October 9, 2021. Applicant was reminded CPR and First Aid training must be renewed every two years. The applicant has proof of immunizations and completed the Mandated Reporter Training on August 24, 2021. LPA informed applicant Mandated Reporter Training must be completed by every staff member hired and must be renewed every two years.

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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: OSTROVSKA, OKSANA
FACILITY NUMBER: 414004840
VISIT DATE: 10/11/2021
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A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. Applicant was advised all assistants, volunteers, frequent visitors or adults living in the home, over the age of 18 must be fingerprint cleared, associated to the home and have proof of immunizations, prior to having any contact with the children in care. Failure to do so could result in an immediate civil penalty of $100 to $300 per person, each day.

Required postings are posted near main entrance of living room. Prior to recommended licensure for large license, following must be completed:

-Fire clearance approval
-Install child safety locks in kitchen cabinets and drawers.
-Install additional padding to fireplace brick.
-Clearing bathroom #1’s counter of everything but soap and hand towels.
-Covering of floor vent in bedroom #4

An exit interview was conducted with applicant, Oksana Ostrovska and H1. Applicant 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 applicant. Applicant was advised to acknowledge receipt of report once received.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
LIC809 (FAS) - (06/04)
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