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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700178
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:48:14 PM

Document Has Been Signed on 09/27/2022 03:48 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:NECHAYEVA, MARINAFACILITY NUMBER:
015700178
ADMINISTRATOR:NECHAYEVA, MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 490-6605
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Marina Nechayeva TIME COMPLETED:
04:00 PM
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On 09/27/2022 approximately at 11:05AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with licensee's fingerprinted and associated helper, Marine M. Due to the lack of spoken English, her helper called licensee for LPA to gain access to the facility. LPA spoke to licensee and disclose the nature of the visit and had explained that she had an appointment at the Apple store to pick up her new phone as her phone was recently stolen. Licensee states that it may take her about an hour to come back; LPA explains to licensee that the visit will still continue. Present for this inspection was licensee's fingerprinted and associated helper, licensee, and five preschool aged children. Also residing in the home is the licensee's fingerprinted husband and their school aged son. The home was toured to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am to 6:00pm.

ON LIMITS: first left-side bedroom #1 (for sleeping), hallway bathroom, fenced backyard, dining area, living room (main day care area), first right side bedroom #2 (across from bedroom #1), right side garden
OFF LIMITS: garage, kitchen, bedroom #3, bedroom #4 (master bedroom), and master bathroom. Off limit areas are inaccessible by closed and/or locked doors, gates, and visual supervision.

The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. At 11:25AM, LPA observed there were ample age appropriate toys and activities that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There was a fully charged 3A40BC fire extinguisher, working dual carbon monoxide and smoke detector, and telephone on the premises. The home has a fireplace but is blocked off by a screen that is properly latched. Per licensee, there are no firearms or pets. The licensee conducts and documents fire drill log indicates a drill was conducted 07/21/22 and earthquake drill on 07/22/2022. All required licensing documents are posted and visible for public review. SEE LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: NECHAYEVA, MARINA
FACILITY NUMBER: 015700178
VISIT DATE: 09/27/2022
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At 11:45AM, LPA toured the backyard area and observed there were two small bodies of water inside a wading pool and water play that were not emptied. LPA informed licensee to completely empty the water play and wading pool after use as it may potentially cause harm to children in care; LPA also observed that the side door of the left side yard and screen garage door was unlocked. Licensee was also reminded to maintain proper supervision of children in care and to ensure all doors and gates are properly locked to prevent any risk at the facility. Zero tolerance was discussed.

At 12:20PM, 6 children's files were reviewed and found that there were 6 out of 6 children's file did not have immunizations documented on required California blue form. See LIC 809D. However based on the facility roster, one daycare child is no longer attending the facility as of 06/30/2022. The facility roster was reviewed, and a copy obtained. The facility is in ratio today. Licensee has proof of the required immunizations. The licensee have required mandated reporter training that is completed as of 11/22/2021; LPA advised licensee to have her helper take the required mandated reporter training and have other documents such as LIC 508, immunizations, and LIC 9052 (Employee Rights) available to review SEE LIC 809D. CPR and First Aid training for licensee is valid until 02/12/2024 and her helper is valid until 07/23/2024. LPA was also made aware that licensee is planning to do some remodeling to her facility and wants to remain open; LPA was advised that remodeling will start on October 8, 2022 and will do the remodeling every other weekend until remodeling is finished. An inspection report is not required per licensee. Remodeling would not be done during week days.

There were 2 deficiencies were cited for today's inspection; SEE LIC 809D
Type B - 6 out of 6 children's immunizations were not documented on required California immunization form
Type B - Licensee does not have a complete staff file available for review; S1 was missing required mandated reporter training, immunizations (MMR, Tdap, flu shot or letter declining it; Tb Skin Test was present), LIC 508 (Criminal Record Statement), and LIC 9052 (Employee Rights) SEE LIC 809 C


SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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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: NECHAYEVA, MARINA
FACILITY NUMBER: 015700178
VISIT DATE: 09/27/2022
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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

LPA discussed the safe sleep regulations with 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 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.


Incidental Medical Services (IMS) policy was discussed. This facility does not provides IMS to children in care. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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.”


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.

SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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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: NECHAYEVA, MARINA
FACILITY NUMBER: 015700178
VISIT DATE: 09/27/2022
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Licensee was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.


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.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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Document Has Been Signed on 09/27/2022 03:48 PM - It Cannot Be Edited


Created By: Kelly Phan On 09/27/2022 at 02:09 PM
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: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as licensee failed to have required forms maintained in her helper's file and was verified by her helper, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2022
Plan of Correction
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Licensee would send corrections to LPA via email by 10/14/2022
Type B
Section Cited
CCR
102418(g)
Immunizations
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as 6 out of 6 children files are not properly documented on California immunization blue form, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2022
Plan of Correction
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Licensee would send corrections via email by 10/14/2022
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: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022


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