013423955-5-31-2024-02-CC-AAKE-D5SQXD-20240531123321

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423955
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:33:48 PM

Document Has Been Signed on 05/31/2024 12:33 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	HRISTOVA, OLGA		FACILITY NUMBER:	013423955
ADMINISTRATOR/ DIRECTOR:	HRISTOVA, OLGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 704-3299
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	05/31/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:18 AM
MET WITH:	Olga Hristova		TIME VISIT/ INSPECTION COMPLETED:	12:00 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	On 5/31/24 at 8:18am Licensing Program Analyst (LPA) Ashley Akinleye arrived at the home for a prelicensing inspection. LPA was met by applicant Olga Hristova and granted access to the premises. There were no children present during the inspection. Applicant states that her hours will be 8:00am - 5:00pm Monday through Friday. LPA toured the premises with applicant Olga Hristova and observed the home to be apart of a duplex. The entrance to the home is on the side of Ada St. and the side of the duplex, which will be the entrance to the day care. LPA observed the home to have two bedrooms, two bathrooms, a kitchen, a living room, a laundry room and backyard. The home was observed to be neat and clean with heating and ventilation for safety and comfort of the children. The on limits areas will be 1 bedroom, the living room, 1 bathroom, the kitchen and backyard. The off limits areas will be 1 bedroom, 1 bathroom, the laundry room. The isolation area will be the on limits bedroom, away from children in care. There are age appropriate toys which are observed to be safe, clean and in good repair. There are no bodies of water or pools accessible to children in care during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HRISTOVA, OLGA	FACILITY NUMBER: 013423955
	VISIT DATE: 05/31/2024

NARRATIVE

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Per Applicant there are no firearms in the home. The home is equipped with a fully charged 3A40BC fire extinguisher and smoke/carbon monoxide dual detectors. Applicant tested the smoke/carbon monoxide for LPA during inspection. LPA observed them to be in working condition. The applicant has current Mandated reporter training which expires 6/9/25 and current CPR/First Aid certificates which expire in 6/10/2025. The applicant currently does not have liability insurance but advises she is looking into it.

Olga Hristova was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Applicant rents this property and has provided both notification and consent to licensing per requirements.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with Olga Hristova the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. PIN 22-05-CCP Page Eight

LPA reminded applicant that until she obtains an assistant she will still need to operate at a small family child care capacity.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HRISTOVA, OLGA	FACILITY NUMBER: 013423955
	VISIT DATE: 05/31/2024

NARRATIVE

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LPA discussed the safe sleep regulations with Olga Hristova and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Olga Hristova 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.

On this date, 4/15/24, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Olga Hristova was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with Applicant Olga Hristova. Appeal rights were provided and a copy of report to review.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication

Large Family Child Care License effective as of 5/31/24.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC809 (FAS) - (06/04)

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