434415154-10-15-2024-07-CC-JBER-DA3S23-20241015132851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415154
Report Date: 10/15/2024
Date Signed: 10/15/2024 01:29:09 PM

Document Has Been Signed on 10/15/2024 01:29 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	DOBROVOLSKAYA, LIUDMILA		FACILITY NUMBER:	434415154
ADMINISTRATOR:	DOBROVOLSKAYA, LIUDMILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 650-8060
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	14	CENSUS: 10	DATE:	10/15/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Liudmila Dobrovolskaya		TIME COMPLETED:	01:40 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	Licensing Program Analyst (LPA), Jennifer “Jen” Beehler, met with Licensee, Liudmila Dobrovolskaya and Staff person #1 (S1), for an unannounced annual Inspection. LPA was granted access to the home by staff person #2 (S2) and toured both indoors and outdoors during the inspection. Upon arrival, there were 10 children (preschool age) and 2 staff persons present, which is compliant with the home license capacity and ratio requirements. LPA was informed the licensee was at a doctor’s appointment that began at 9:30 AM and would be back shortly. S1 was called to conduct the inspection as she was the second person in command and spoke better english than licensee. S2 stated when licensee was not present, S1 was the one in charge. S1 arrived 10 minutes later at approximately 9:50 AM. Licensee arrived approximately 10 minutes after that at 10:00 AM. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are Monday – Friday, 08:00AM-06:00PM. There are no active waivers or exceptions. S1 states that licensee is the only adult living in the home. Licensee and S1 were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA reviewed facility roster (LIC9040) and observed 12 children enrolled, none of the children in care are under the age of 2. The fire/disaster drill log was posted at the entrance and stated the last fire/disaster drill and earthquake preparedness drills were conducted on 08/09/2024, which is compliant with the six-month requirement for homes. LPA observed a 3A40BC fire extinguisher with the year 2024, functioning smoke detector and carbon monoxide detector. Licensee states that she does not currently have any children in care who require Incidental Medical Services. The Licensee states that there are no weapons or firearms in the home. Continued on Page 2

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer Beehler	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DOBROVOLSKAYA, LIUDMILA	FACILITY NUMBER: 434415154
	VISIT DATE: 10/15/2024

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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: https://www.ada.gov/resources/child-care-centers/.

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas of the home (indoors): Bedroom #3, Master Bedroom with bathroom en suite and office. There are no open-faced heaters in the home. There is a fireplace in the day care area that is inaccessible from children in care by a book shelf that is positioned in front of it. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. LPA observed separate files at the entrance where staff can share the art and things children did for the day. Drinking water is readily available for children in the facility via purchased water jugs, plastic cups and personal water bottles that children bring from home for when the children are in the backyard playing. There is a dedicated bathroom for the children that is off the main day care room. It has two toilets and a double sink that is lower to accommodate young children. There is an additional adult bathroom separate for staff. The bathrooms are clean, sanitary, and operable. The Licensee has a cell phone and land line for a working telephone at the facility. There is one step from the day care room to the kitchen, a gate barricades this area from children in care. S1 stated they open the gate when they are putting children in the sleeping room and walk them through the kitchen to that room, supervised. LPA observed this to be true. Otherwise the gate is closed keeping the step inaccessible from children.

The backyard area of the home was inspected. LPA observed sufficient play equipment and supplies for the children that are in good condition and age-appropriate. There was shade provided by canopies, bikes, toy Lego's, tan bark under play structures. Off-limit areas outside of home include: the front and side yards. No outdoor bodies of water were observed during todays inspection.

Continued on Page 3

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer Beehler	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DOBROVOLSKAYA, LIUDMILA	FACILITY NUMBER: 434415154
	VISIT DATE: 10/15/2024

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
26
27
28
29
30
31
32

LPA discussed the safe sleep regulations with licensee 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 licensee of 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.

6 (Six) children’s files were reviewed during todays inspection and all required documents were present. All staff files were reviewed including licensee. All staff members had a current CPR/First-Aid that expires 02/24/2026. All staff, including licensee, had current Mandated Reporter Training that expires on 06/30/2024 and LPA reminded that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. Licensee states she speaks with parents every day at pick up and shares the work and art they created.

Licensee was informed of the www.MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the Licensee, Liudmila Dobrovolskaya and S1 so the this report could be translated into English. As a result of today's inspection, no deficiencies were cited. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer Beehler	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3