434415675-10-14-2019-07-CC-TDON-BGXS4M-20191014133258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415675
Report Date: 10/14/2019
Date Signed: 10/14/2019 01:33:06 PM

COMPREHENSIVE INSPECTION

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:	BASHIROVA, LIUDMILA		FACILITY NUMBER:	434415675
ADMINISTRATOR:	BASHIROVA, LIUDMILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	4086573157
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	14	CENSUS: 10	DATE:	10/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Liudmila Bashirova		TIME COMPLETED:	01:35 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) Tuoc Doan conducted an unannounced Annual Inspection of the Family Day Care home. Upon arrival, LPA observed present were Licensee, and Licensee's spouse Dmitriy Semenov and Assistant Providers Natalia Dolgov, Nino Makhatchashvilli, and Nina Shilina. LPA met with Licensee Liudmila Bashirova and explained the purpose of the inspection. Ten children were in care, of whom one was infant age (Licensee's own child). Licensee stated that she understands that when she has more than 12 and up to 14 children, one child has to be enrolled in school and one child has to be at least 6 years old. Licensee also stated that she understands she must comply with the capacity requirement of a small Family Child Care Home whenever there is only one care provider home with the children. The home’s operating days and hours are Monday through Friday from 08:00 AM to 06:00 PM. The home maintains telephone service. The License and Notification of Parents’ Rights were observed to be posted. The home was inspected inside and out. The home was clean and orderly. LPA did not observe flies, other insects, or rodents during the inspection. The observed children’s toys, play equipment, and furniture were in good condition. There were no baby walkers at the day care. Restroom used by children was observed to be clean and in operating condition. Food preparation area was clean. Off Limit Ares are: the Garage, Master Bedroom, Room 2, Room 3, Kitchen, bathroom adjacent to Room 1, and detached storage shed in the backyard. The backyard is fenced and it is divided into two areas; one for day care outdoor activity and the other area where the pool is located is off limits. The pool was surrounded with a fence. LPA informed Licensee that photos of the swimming pool and its fencing were taken for review in regards to compliance fencing requirements. Licensee stated that there were no weapons stored on the premises. A fully charged fire extinguisher was observed. Carbon monoxide and Smoke Detectors were observed. Fire/Disaster Drill log recorded that the last drill was conducted on 08/26/19 and 08/29/19.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019

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

FACILITY NAME: BASHIROVA, LIUDMILA	FACILITY NUMBER: 434415675
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/14/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/28/2019 Section Cited	1 2 3 4 5 6 7	APPLICATION FOR LICENSE. Licensees and any adult in the home, shall provide evidence of a current tuberculosis clearance, performed and signed by a physician not more than one year prior to or seven days after first day of employment. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Per LPA's review of records, Licensee failed to provide evidence of a current Tuberculosis Clearance for Assistant Providers Nino Makhatchashvilli and Galina Odintsova. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019

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

FACILITY NAME: BASHIROVA, LIUDMILA	FACILITY NUMBER: 434415675
	VISIT DATE: 10/14/2019

NARRATIVE

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Licensee stated that the day care does not provide transportation to the children. The home has a pet cat and rabbit. LPA reviewed and obtained a copy of the roster of children. Children’s files were reviewed, which included records of Identification and Emergency Information, Consent for Emergency Medical Treatment, Receipt for Parents' Rights Notice, and Immunization. Licensee and Assistant Providers Natalia Dolgov, Nino Makhatchashvilli, and Nina Shilina's files were reviewed, which included record for Criminal and Child Abuse Background Check Clearance, immunization, required Training etc. Licensee's AB1207 Mandated Reporter Training Certificate expires on 08/12/21 and her Pediatric CPR/1st Aid Certificate expires on 05/25/21.

Licensee stated that Licensee and Licensee's spouse are the only two adults who reside in the home. They have Clearances for Tuberculosis, and Criminal Background and Child Abuse Index Checks. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA reviewed and provided a copy of the “Lead Poisoning Facts Information Flyer” and Safe Sleep information to Licensee.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does not have any children in care who requires IMS. 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) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

In the areas that were evaluated, regulatory violation was observed at the time of the inspection.
Exit interview was conducted, where this report, the violation, plan of correction, and appeal rights were reviewed with Licensee.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019

LIC809 (FAS) - (06/04)

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