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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422917
Report Date: 10/06/2020
Date Signed: 11/09/2021 02:31:45 PM

Document Has Been Signed on 11/09/2021 02:31 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GRUZMAN, CHANAFACILITY NUMBER:
013422917
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/06/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Chana GruzmanTIME COMPLETED:
02:45 PM
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On 10/06/20 at 2:00pm, Licensing Program Analyst (LPA) Briana Plumboy conducted an announced Case Management Inspection via Facetime with Licensee Chana Gruzman. Present for the inspection was licensee’s fingerprint clear and associated husband Shneur Gruzman and licensees 6 children (2 infants, 2 preschool age, and 2 school age). The home was virtually toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am until 6:00pm.

ON LIMITS: the dining room, living room, kitchen/dining room combo, and family room. Also on limit is the bedroom located inside the left hallway first on the right, the bedroom located at the end of the hallway, both downstairs bathrooms, and the first level of extension of the home off the right of the kitchen

OFF LIMITS: the master bed/bath/closet, laundry room, and the entire upstairs portion of the home

The home has two levels. The home consists of a living room, family room, dining room, kitchen/dining room combo, 2 bedrooms, 2 bathrooms, a master bedroom/bathroom/closet, a laundry room, and an extension of the home which can be accessed through the home by a door located in between the laundry room and bathroom. The isolation area will be will be the first bedroom on the right located inside the hallway on the left of the dining room. There are 2 fire extinguishers, carbon monoxide detector, pull down fire alarm, and smoke detector which meet State Fire Marshall standards during today's inspection.

Per licensee, there are no firearms in the home. There are no pets in the home. All required licensing documents are posted and visible for public review. The licensee's Pediatric CPR/First Aid certificate is current and expires 11/2021. Licensee's mandated reporter training was completed on 09/29/20. Licensee is in compliance with the immunization law. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2020
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GRUZMAN, CHANA
FACILITY NUMBER: 013422917
VISIT DATE: 10/06/2020
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On 09/21/20, a fire clearance was granted to facility #013422917 by Alameda County Fire Department. The second story of the home cannot be used at anytime. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .

As of 10/06/20, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. This entire report has been read to the Licensee by LPA Plumboy. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Plumboy or CCLD. An exit interview was conducted, and appeal rights provided.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2020
LIC809 (FAS) - (06/04)
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