<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700476
Report Date: 06/19/2024
Date Signed: 06/25/2024 08:49:58 AM

Document Has Been Signed on 06/25/2024 08:49 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SAMOILENKO, SVITLANA & KAMYNINA, YULIIAFACILITY NUMBER:
015700476
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
06/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Licensee,Yulia Kamynina, Svitlana SamoilenkoTIME VISIT/
INSPECTION COMPLETED:
02:40 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
Licensing Program Analyst (LPA) Jyoti Saini met with Licensees Svitlan Samoilenko and Yuliia Kamynina for the Annual Random Inspection. The LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Both licensees were present during this inspection, supervising three (3) children (two infants and one preschooler). The Licensee rents this house and lives in this house with licensee Yulia Kamynina and her son. Both licensee's primarily speak Russian. Licensee's sister, Maryna Koroliuk, was there to help translate today. The home consists of 3 bedrooms, including a Master bedroom, attached Bathroom, hallway bathroom, hallway two closets, living room, dining room, kitchen, backyard, and garage. The hours of operation are 7:30 am to 6:00 pm, Monday -Friday.
ON LIMIT AREAS are the dining room, living room (main play area), bedroom #3 (master bedroom and adjacent bathroom), located on the right side of the hallway, and backyard.
OFF LIMIT AREAS: Bedroom #1 and bedroom #2 are located on the left side of the hallway, hallway bathroom, two closets in the hallway, a garage, a detached room in the backyard, and three storage sheds in the backyard.
LPA inspected the house for health and safety hazards. The daycare area is clean, orderly, and equipped with age-appropriate toys and equipment for children, indoors and outdoors. The home has a working telephone, a smoke and carbon monoxide detector, and a fire extinguisher meeting the minimum requirements. There are no bodies of water in the daycare area. A fireplace in the daycare room is barricaded with the toy shelves. The Licensee conducts and documents Fire/Disaster Drills; the log indicates a drill was conducted on 05/2024. There are ample of age-appropriate toys that appear safe and in good condition. Each child has a separate cot and blanket. Per licensee, bedding is washed weekly. The Licensee states there are no guns or weapons of any kind in the home. The outdoor play area is fenced and is free from defects and dangerous conditions. Both the Licensees have a valid CPR and first aid certificate and mandated reporter certificate on the file. . The Licensee provides daily snacks and meals. LPA reviewed children's files. All the files are complete and up to date. All required postings are properly posted. Licensee has complete record of 15 minutes sleep check
See the next page.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SAMOILENKO, SVITLANA & KAMYNINA, YULIIA
FACILITY NUMBER: 015700476
VISIT DATE: 06/19/2024
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
26
27
28
29
30
31
32
During Inspection, 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.

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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at 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/inspection-process.

No deficiency is cited today.

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

Exit interview conducted and report was reviewed with the licensee, Svitlana Samoilenko and Yuliia Kamynina.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2