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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700178
Report Date: 05/07/2024
Date Signed: 05/07/2024 01:10:29 PM

Document Has Been Signed on 05/07/2024 01:10 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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:NECHAYEVA, MARINAFACILITY NUMBER:
015700178
ADMINISTRATOR/
DIRECTOR:		NECHAYEVA, MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 490-6605
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
05/07/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Marine MaloyanTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
NARRATIVE
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On 05/07/2024 at 9:45AM, Licensing Program Analyst (LPA) Jaleesa Jackson met with Facility Representative Marina Maloyan for a Plan of Correction (POC) visit. Present during the inspection were 4 infants and 1 preschool aged child. Licensee Marina Nechayeva was not present at the home when LPA arrived.

Licensee's assistant was by herself supervising 4 infants and 1 preschool aged child. This is a repeat violation from 4/23/2024. LPA tried calling the Licensee and left a voicemail to informer her of the visit. Licensee was reminded on 4/23/2024 that when only one adult in the home the facility is to operate as a small Family Child Care Home. Today the facility is operating out of ratio for a second time. LPA gave a POC for 2 deficiencies that were due 4/24/2024 where the requirements to clear the POC have not been meet. One deficiency was regarding infant safe sleep and the other was for operating out of ratio. Failure to correct a POC will result in a $100 per day civil penalty until corrected.

There was 1 deficiency cited on today's visit. See 809-D for deficiency.

LPA Jackson informed Facility Representative that this report dated 5/7/2024 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Jackson informed the Facility Representative that the licensee to provide a copy of this licensing report dated 5/7/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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Document Has Been Signed on 05/07/2024 01:10 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 05/07/2024 at 10:40 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: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/08/2024
Section Cited
CCR
102416.5(e)

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If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
This requirement is not met as evidenced by:
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Licensee will disenroll one infant until one of the other infants turn 2 years old so she can operated in ratio. Proof of disenrollment will be verified by a POC visit. Licensee will also write a signed and dated statement that she will be in compliance with being in ratio.
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Based on observation and record review, the licensee did not comply with the section cited above by operating out of ratio which posed an immediate 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.

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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:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: NECHAYEVA, MARINA
FACILITY NUMBER: 015700178
VISIT DATE: 05/07/2024
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days.

Appeal rights have been provided.

Exit interview conducted and report was reviewed with the Facility Representative Marine Maloyan with the assistance of a translator service (interpreter #16423831). A copy of this report was also emailed to Licensee Marina Nechayeva.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
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