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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700384
Report Date: 10/05/2022
Date Signed: 10/05/2022 12:52:02 PM

Document Has Been Signed on 10/05/2022 12:52 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:ZAYMAK, DINAFACILITY NUMBER:
015700384
ADMINISTRATOR:ZAYMAK, DINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 921-5033
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
10/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Dina Zaymak TIME COMPLETED:
01:15 PM
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On 10/5/2022, approximately at 11:25AM, Licensing Program Analyst Kelly Phan met with applicant Dina Zaymak for unannounced case management visit for location change from 38627 Cherry Lane Apt #56 Fremont, CA 94536 (#015700158) to 4540 Stevenson Blvd, Fremont CA 94538. Presented during today's health and safety inspection was just the applicant. Also residing in the home is the applicant's fingerprinted and associated husband and their 12 years old daughter. Hours of operation will be Monday to Friday between 8:30AM to 5:30PM.

The applicant's home is a single story home that is neat and clean with heating and ventilation to provide safety and comfort . The home has a fully charged 2A10BC fire extinguisher, working dual carbon monoxide and smoke detectors, and working telephone. LPA reviewed a lease agreement that shows applicant renting the property; There is also LIC 9151 (Landlord Notification form) and LIC 9149 (Landlord Consent) on file. The areas of the day care will consist of living room, kitchen, dining room, main day care area, bathroom #1 in the day care area, fenced backyard, left and right side yards. LPA observed there were ample age appropriate toys and activities for children to utilize. The OFF LIMIT areas are 3 bedrooms, hallway bathroom, garage, outdoor shed, and front yard. OFF limit areas have a gate or closed/locked doors to prevent access to those areas. At 11:45AM, LPA and applicant toured the backyard area and observed and is free from defects or dangerous conditions. Applicant has started building a sandbox for children to utilize; LPA reminded applicant to notify Licensing of any remodeling or construction to the facility such as in built pools or room additions; Applicant understood. There are no pools, hot tubs or any other bodies of water on the premises. Per applicant, there are no firearm or no one who smokes at the home. Applicant does have a cat at the facility. All hazardous materials and toxins are made inaccessible to children. Applicant has first aid kit located in the kitchen area. Facility also has a fireplace in the living room area, however it is closed with a glass mirror.

SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: ZAYMAK, DINA
FACILITY NUMBER: 015700384
VISIT DATE: 10/05/2022
NARRATIVE
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At 12:15PM, LPA reviewed the facility file with applicant. Both applicant and her fingerprinted and associated helper has completed the preventive health and safety training, CPR and First Aid certificates are valid from 08/13/22 until 08/1/2024; helper's training is valid from 08/18/2021 to 08/01/2023 . Both applicant and her helper also has completed the Mandated Reporter training on 12/14/2021 and 03/05/2022 and have required immunizations and declaration of declining the flu on file. There are required forms posted for public review such as emergency disaster plan with facility sketch plan; Applicant has not completed fire drill yet as she has just moved to the area recently. LPA suggests applicant to start conducting fire drills once she has children at her facility. Per applicant, she is planning to obtain liability insurance sometime this week, but is aware to provide LIC 282 (Affidavit of Liability insurance) to families along with LIC 9150 (Additional Children). Applicant also mentioned that transportation would be provided once a week for outdoor trips to a neighboring park; LPA discussed with applicant of having a current drivers license, car insurance, obtaining parent's consent, maintaining appropriate car capacity and car seats, as well as having an operable vehicle to drive. Applicant understood.

Facility received fire clearance on 09/22/2022 to operate as a large family child care, garage is OFF limits for day care. This home is recommended for licensure on 10/05/2022. This report shall remain on file for 3 years. Exit interview conducted and appeal rights were given with applicant, Dina Zaymak

Applicant 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, 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: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
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: ZAYMAK, DINA
FACILITY NUMBER: 015700384
VISIT DATE: 10/05/2022
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

Incidental Medical Services (IMS) policy was discussed. 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.”

LPA discussed the safe sleep regulations with applicant 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 APPLICANT 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.

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 platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC809 (FAS) - (06/04)
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