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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415810
Report Date: 08/15/2019
Date Signed: 08/15/2019 12:12:29 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:UMANSKY, SVETLANAFACILITY NUMBER:
434415810
ADMINISTRATOR:UMANSKY, SVETLANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 224-6693
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY:14CENSUS: 9DATE:
08/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Svetlana UmanskyTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Marilou Monico and Pete Hernandez, made an unannounced annual random inspection. LPAs met with Licensee, Svetlana Umansky, and explained the nature of today's visit. Also present in the home were licensee's 14 year old daughter, 3 adult helpers, and 9 preschool age children. Days and hours of operation are Monday to Friday from 8:00 AM to 6:00 PM. Licensee is the only adult living in the home. Licensee's children ages 14 and 7 years old also reside in the home. LPAs reminded licensee that children living in the home who are under the age of 10 are counted in the ratio.

LPAs toured the home both indoor and outdoor. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly. There is a fully charged 2A10BC fire extinguisher, working smoke detector, functioning carbon monoxide detector, glass covered fireplace, and no bodies of water. Off limit areas inside the home, bedroom #1 (master bedroom), master bathroom, kitchen, bedroom #2, and garage. Off limit areas outside the home, left gated side yard. Medications, cleaning compounds, sharp objects, and other similar items are stored out of reach of children. Per licensee, there are no weapons in the home. Ten children's files and three helper's files were reviewed. Licensee maintains a current children's roster and fire drill log. LPAs obtained copy of children's roster. Licensee has current CPR/First Aid certifications with an expiration date of September 2019. The home has a working telephone which is (650) 224-6693.

LPAs discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. Licensee has completed the Mandated Reporter Training.

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 provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

(REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 08/15/19):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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 4
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: UMANSKY, SVETLANA
FACILITY NUMBER: 434415810
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2019
Section Cited
CCR
102370(d)(1)&(2)
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CRIMINAL RECORD CLEARANCE - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility shall: Obtain a California clearance or a criminal record exemption as required by the Department or Request a transfer of a criminal record clearance.
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Licensee submitted transfer request and Yekaterina's identification to Licensing during the inspection together with written plan of correction.
Deficiency corrected.

Civil penalty of $1,000.00 was assessed during the inspection.


Deficiency corrected.
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This requirement is not met as evidenced by: Licensee's adult helpers, Yekaterina Kouliev and Natalia Grivnin, have been working at the facility without fingerprint clearances or fingerprint clearances associated to the facility. This poses an immediate risk to the health and safety to children in care.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: UMANSKY, SVETLANA
FACILITY NUMBER: 434415810
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2019
Section Cited
HSC
1597.622(a)(1)
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Employee and Volunteer Immunization - Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
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Licensee states she will submit proof of missing immunizations by 09/16/19.
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 This requirement is not met as evidenced by: Helper #2 is missing immunization in measles, and pertussis. Helper #3 is missing immunization in measles, pertussis, and influenza. This poses a potential risk to the health and safety to children in care.
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Type B
09/16/2019
Section Cited
CCR
102416.1(a)
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Personnel Records - Personnel records shall be maintained on each employee. This requirement is not met as evidenced by: Helper #3 is missing Criminal Record Statement (LIC 508), Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), and TB test. This poses a potential risk to the health and safety to children in care.
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Licensee states she will submit completed documents by 09/16/19.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: UMANSKY, SVETLANA
FACILITY NUMBER: 434415810
VISIT DATE: 08/15/2019
NARRATIVE
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(CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/15/19):

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemption with the exception of licensee's helpers, Yekaterina Kouliev and Natalia Grivnin. Yekaterina has fingerprint clearance but not associated to the facility. Natalia Grivnin has no fingerprint clearance. LPAs 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

As a result of this inspection, deficiencies were cited on the following pages:



NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4