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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700178
Report Date: 11/29/2022
Date Signed: 11/29/2022 11:14:11 AM

Document Has Been Signed on 11/29/2022 11:14 AM - 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:NECHAYEVA, MARINAFACILITY NUMBER:
015700178
ADMINISTRATOR:NECHAYEVA, MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 490-6605
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
11/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Marina NechayevaTIME COMPLETED:
11:20 AM
NARRATIVE
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On 11/29/2022 approximately at 9:05AM Licensing Program Analyst (LPA) Kelly Phan met with Marina Nechayeva (Licensee) for the purpose conducting a case management inspection to verify if corrections were made. Present for this inspection was a fingerprinted and associated helper along with 1 infant (9 months old) and 5 preschool aged children in care. The facility is in ratio today. LPA entered the facility and began the inspection of the facility to conduct a health and safety check.

At 9:20AM, LPA was made aware that an infant had started attending the day care this month and will get another infant starting next year. LPA observed that the infant was put to sleep in the right side bedroom, which the bedroom door was closed and child was sleeping on his tummy. LPA advised that the bedroom door has to remain open, so licensee is able to see and hear the infant without moving the door. LPA discussed safe sleep regulations with licensee. Licensee was also advised to begin conducting 15 minutes sleep checks; a sleep log was given to licensee to use today.

Two Type B deficiencies were cited on 09/27/2022 for record keeping and had a plan of correction date for 10/14/2022. However it was then extended to 10/18/2022 per licensee's request. Licensee informed LPA that corrections were not made due to both her helper and herself getting sick. As of 11/29/2022, LPA observed that the licensee have some completed documents for her helper, however she is still missing some required documents such as mandated reporter training.Therefore the facility is getting recited for the above deficiencies. SEE LIC 809D

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Marina Nechayeva


SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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Document Has Been Signed on 11/29/2022 11:14 AM - It Cannot Be Edited


Created By: Kelly Phan On 11/29/2022 at 10:04 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: NECHAYEVA, MARINA
FACILITY NUMBER: 015700178

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2022
Section Cited
CCR
102416.1(a)

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102416.1 Personnel Records: (a) Personnel records shall be maintained on each employee and shall contain the following information...This requirement was not met as evidenced by:
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Licensee would assist her helper to have required forms and trainings completed and send corrections to LPA by 12/6/2022
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Based on interview, the licensee did not comply with the section cited above as licensee failed to have required forms and training for her helper's file, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
11/29/2022
Section Cited
CCR102418(g)(1)

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102418(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1)This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement was not met as evidenced by:
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Licensee would fill out and maintain immunizations on California blue immunization forms for all children enrolled at her facility

Licensee would send correctiosn to LPA via email by 12/6/2022
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Based on interview, the licensee did not comply with the section cited above as licensee failed to maintain children's immunizations, which poses a potential health, safety or personal rights risk to persons in care.
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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:Jason Jang
LICENSING EVALUATOR NAME:Kelly Phan
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


LIC809 (FAS) - (06/04)
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