015700384-10-20-2023-52-CC-JJAN-CWSRG5-20231020130009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700384
Report Date: 10/20/2023
Date Signed: 10/20/2023 01:00:22 PM

Document Has Been Signed on 10/20/2023 01:00 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:	ZAYMAK, DINA		FACILITY NUMBER:	015700384
ADMINISTRATOR:	ZAYMAK, DINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 921-5033
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	10/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Dina Zaymak		TIME COMPLETED:	01:05 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 10/20/2023 at 9:50AM Licensing Program Analyst (LPA) Jaleesa Jackson arrived for an Unannounced Annual inspection and met with Licensee Dina Zaymak. LPA informed licensee of the nature of the visit and was granted entry into the home. Present at during the inspection was the Licensee, a fingerprint cleared adult volunteer, Licensees teenage daughter and eleven (11) preschool aged children. Also residing in the home is the licensee's fingerprinted cleared husband. The home was toured with the Licensee to conduct a health and safety inspection. Hours of operation for the day care are Monday through Friday, 8:30AM to 5:30PM. ON LIMITS: Family Room (main day care room), Dining Room, Kitchen, Living Room, Bathroom #1, and the Backyard OFF LIMITS: All three Bedrooms, Bathroom #2, the hallway leading to bedrooms, and the Garage. ISOLATION AREA: Living Room At 10:00AM LPA toured the home. The home is a single story home that is rented by the Licensee. The inside and outside of the home were observed to be neat with ample age appropriate materials for the children. The home is equipped with central heat and air for proper ventilation. The electric fireplace in the living room has disconnected, making it inaccessible to the children in care. During todays inspection LPA observed that all toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible to children. Off limits areas are made inaccessible with safe gates, closed doors, and visual supervision. The home has one (1) fully charged 2A10BC fire extinguisher in the kitchen. There is one (1) working combination smoke/carbon monoxide detector in family room. There are no pools, hot tubs or any other bodies of water on the premises. Licensee stated that there are no firearm and no one who smokes at the home. Licensee has one cat and one fish in the home. Continued 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZAYMAK, DINA	FACILITY NUMBER: 015700384
	VISIT DATE: 10/20/2023

NARRATIVE

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Licensee is operating within the licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed. Licensee has current Pediatric CPR First Aid that expires 08/2024. Licensee’s Mandated Reporter training is complete and expires 12/14/2023. Licensee's volunteer has a statement of good health for vaccinations and will have the vaccinations for Licensee to have on file. LPA observed that the last fire drill was not completed at least every six months the last drill was conducted on 04/17/2023. Licensee stated that she plans on doing a fire drill next week when her assistant is back. All required postings are made visible by the front door of the home. LPA reviewed eleven (11) children's files and that all were complete. Licensee stated that she has liability insurance and provided a copy for LPA to view. LPA reviewed and obtained a copy of child's roster.

There were no deficiencies cited on today's inspection.

Licensee was reminded that California Law requires Licensee 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 (LIC624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, 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.

Continued 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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: ZAYMAK, DINA	FACILITY NUMBER: 015700384
	VISIT DATE: 10/20/2023

NARRATIVE

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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-andresources/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. For IMS information see PIN 22-02- CCP. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Dina Zaymak, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Dina Zaymak.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC809 (FAS) - (06/04)

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