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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416238
Report Date: 03/02/2022
Date Signed: 03/02/2022 03:35:16 PM


Document Has Been Signed on 03/02/2022 03:35 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:MURZIANKOVA, KATSIARYNA & CAMACHO, JAIMEFACILITY NUMBER:
434416238
ADMINISTRATOR:KATSIARYNA & JAIMEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 542-9331
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 11DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Katsiaryna MurziankovaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Aman Sharma met with Licensee, Katsiaryna Murziankova for an unannounced Required – 1 year annual inspection. LPA was granted access to the home immediately by the Licensee. LPA also observed two infants, eight children and one other adult in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. About thirty minutes later, licensee Jamie Camacho also entered the facility. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. Licensees Katsiaryna Murziankova, Jaime Camacho as well as Solange Cavalvante are the only adults residing in the home. An updated LIC 279 reflecting Solange as other adults residing in the home was handed to LPA during todays visit.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on February 18, 2022. Licensees have current CPR and First Aid certifications (expiration: 09/13/2023). Licensees have the required vaccines (MMR, Tdap, & flu - opt out) and are both current with Mandated Reporter Training for Child Care Workers (expiration: 02/26/2024). LPA reviewed eleven preschool child's files and each file was complete with all the required forms. LPA reviewed one staff file and the file was complete with the required forms. Licensee states that a child will be isolated in the master bedroom with access to their own restroom, if necessary due to illness or communicable disease.
LPA discussed the safe sleep regulations with the 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 the 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.

LPA toured the indoor and outdoor areas of the home during today's inspection. The home is clean, orderly, (including heating/air conditioning/ventilation), and safe for the day care children.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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: MURZIANKOVA, KATSIARYNA & CAMACHO, JAIME
FACILITY NUMBER: 434416238
VISIT DATE: 03/02/2022
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There are no wall heaters in the home. The Living Room has a fireplace, but is boarded off. The off limit areas inside the home are: Bedroom number two and kitchen. Licensees stated that they were unaware of the kitchen being off-limits, but included it on their physical plant. A technical assistance was given to the licensees. Licensees and LPA will work together in figuring out if the kitchen can be updated to being an on-limit area.

There are safe and age appropriate toys, play equipment, and materials for the children in the home. LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors. The Licensees state that they do not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensees state that there are no poisons in the home. Licensees state that they do not administer any medication to the day care children at this time. Licensee has a first aid kit in the home which includes a touch less thermometer.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Supervision of children was discussed with the Licensee and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensees understand their capacity options and understand that they cannot have more than 14 children in the home at any time. Licensees state that they do not transport any day care children. Licensees understand that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.


To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

Exit interview conducted and report was reviewed with the Licensee, Katsiaryna Murziankova.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
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