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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408984
Report Date: 10/19/2021
Date Signed: 10/19/2021 04:16:25 PM

Document Has Been Signed on 10/19/2021 04:16 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:KUNIN, OLENAFACILITY NUMBER:
073408984
ADMINISTRATOR:KUNIN, OLENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 922-9644
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
10/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Olena KuninTIME COMPLETED:
04:30 PM
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On 10/19/21 at 1pm, Licensing Program Manager (LPM) Loretta Dyson and Licensing Program Analyst (LPA) Ashley Curry arrived at the facility for an unannounced required inspection. LPM and LPA met with the licensee. There were 3 infants and 5 preschool age children also present. The licensee's school age child was also present. LPM and LPA toured the areas of the home that are used for children in care, with the licensee, to conduct a health and safety inspection.

The home is a single story home which is neat and clean with heating and ventilation for safety and comfort. The home consists of the living room, family room, kitchen, garage, 4 bedrooms and 2 bathrooms. The OFF LIMIT AREAs include the kitchen, the master bedroom, the master bedroom, 2 bedrooms at the far end of the hallway and the garage. These areas are made inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAs include the living room, the first bedroom bedroom on the left side of the hallway, and the hallway bathroom. The ISOLATION AREA will the area just inside the front door, where there is a bench for children to rest, away from other children in care. The outdoor play area will be the fenced backyard, which is free from defects or dangerous conditions. There is an ample supply of age appropriate furniture, equipment, toys and activities that are safe and appear to be in good repair. LPM and LPA did not observe any hazardous items, toxins or medications accessible to children today. LPM and LPA observed an in-ground pool in the backyard. The backyard is split into two areas by a fence. The pool is on one side of the fence and an area for children has been set up on the other side of the fence.

The home has a fully charged 3A40BC fire extinguisher, pull down alarm, combination smoke/carbon monoxide detector, telephone, and first aid supplies. The licensee's CPR/First Aid certificates are current and expire on 11/19/22. The licensee completed the required mandated reporter training in May 2021. The last fire/disaster drill is documented as being conducted on 6/20/21. LPM and LPA viewed the postings, including those related to COVID-19, and verified that all required postings are visible. LPA reviewed children's files and observed that some files do not include immunizations.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2021
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 8
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KUNIN, OLENA
FACILITY NUMBER: 073408984
VISIT DATE: 10/19/2021
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LPM reviewed the ratio and capacity for a large family child care home, and reminded the licensee that an assistant, who is at least 14 years of age, must be present in the home and helping to care for children. LPM advised the licensee that if assistant is not present, the ratio and capacity requirements for a small family child care home must be followed.

No IMS Service provided at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: 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 maximum per day/per person will be assessed if this regulation is violated.

LPM discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licening/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.

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.

There are no deficiencies being cited today. This report will remain on file for 3 years. A Notice of Site Inspection was provided and the licensee was reminded that it must remain posted for 30 days. An exit interview was conducted and appeal rights were provided.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
LIC809 (FAS) - (06/04)
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