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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414531
Report Date: 12/08/2023
Date Signed: 12/08/2023 03:37:11 PM


Document Has Been Signed on 12/08/2023 03:37 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:LUKISH, OKSANAFACILITY NUMBER:
434414531
ADMINISTRATOR:LUKISH, OKSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 390-7508
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:14CENSUS: 8DATE:
12/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Oksana LukishTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Oksana Lukish, Licensee, for an unannounced case management inspection. LPA also observed Licensee's mother/adult assistant (Ninel Kotliarenko), Licensee's spouse (Maksym Lukish), and 8 day care (1 infant - 23 months old & 7 preschool) children in the home during today's inspection.

Licensee states that she does not enroll children younger than 12 months in her day care. Licensee states that she understands the requirements of "safe sleep" for children younger than 24 months, including the infant sleep log. LPA reviewed the infant sleep log for one infant child present during today's inspection and the sleep log was complete.

Licensee provided LPA with an updated copy of her CPR/First Aid certifications (expiration: 11/11/2025) for herself and updated flu vaccination records for herself and her mother/adult assistant (Ninel Kotliarenko).

Exit interview conducted and report was reviewed with the Licensee, Oksana Lukish. No deficiencies issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2023
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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