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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700476
Report Date: 08/14/2024
Date Signed: 08/14/2024 10:16:41 AM

Document Has Been Signed on 08/14/2024 10:16 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: 5DATE:
08/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Samoilenko, Svitlana & Kamynina, YuliiaTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Jyoti Saini met with licensees, Samoilenko, Svitlana & Kamynina,Yuliia for a CASE MANAGEMENT VISIT - INCREASE IN CAPACITY. All adults requiring background clearance have been cleared and associated with this facility. Present during this inspection was Licensees, supervising five children (two infants and three preschoolers). Both licensees 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. The facility has an approved fire clearance from Dublin Fire Prevention Services.
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.
There are no pools, hot tubs, ponds, or other bodies of water. All hazardous materials and toxins were observed to be made inaccessible to children. The dinning area and kitchen are sectioned into two parts with the baby gate. The home has fully charged 2A-10-BC fire extinguishers, a working smoke detector, a working carbon monoxide detector, and a working telephone. Per Licensees, there are no firearms in the facility. Licensee's CPR and first aid certificate are current and expires 04/28/2025. The Licensees has current immunization records on file. There are no pets in the home. The facility provides lunch and snacks. All required postings are properly posted. LPA discussed safe sleep guidelines and 15-minutes check requirements.
Staff-children’s ratios were discussed with the Licensee for a Large Family Childcare Home (FCCH).
If there is no helper, the Licensee will need to operate within the small FCCH in regard to ratios. If care is provided to the 7th and 8th child for a Small FCCH or the 13th and 14th child for a Large FCCH, the last two children need to be school-aged (6 years old).

see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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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: 08/14/2024
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Licensees are reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible.

During Inspection, Licensees were 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.



Licensees were 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

Large Family Day Care License is recommended effective today, 08/14/2024.

Exit interview conducted and report was reviewed with both the licensees, Samoilenko, Svitlana and kamynina Yullia.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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