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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409093
Report Date: 11/17/2022
Date Signed: 11/17/2022 01:11:45 PM

Document Has Been Signed on 11/17/2022 01:11 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:KOMAROVA, GALINAFACILITY NUMBER:
073409093
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Galina KomarovaTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management/ increase in capacity inspection. LPA met with Licensee Galina Komarova and toured the home. There were 2 preschool aged children and 2 infants in care. Licensee has an approved fire clearance dated 9/26/22. Fire clearance is granted for the first floor only.

On limits area used for child care include the living room, dining room and bathroom located on the first floor. The remainder of the home is off limits to children and will be made inaccessible by use of gates, closed and/or locked doors and visual supervision The fenced backyard will be used for outdoor play. There are age appropriate toys in the home. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. There are no firearms in the home as stated by licensee. LPA did not observe any hazardous materials or toxins accessible to children today. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 2A10BC fire extinguisher. The home has a fireplace that is barricaded to prevent access by children. Stairs are gated.

Licensee has current CPR/First Aid which expires 01/24. Licensee completed mandated reporter training 12/22/20. Licensee is in compliance with required immunizations for child care providers. An annual required inspection was also completed today. Files reviews were conducted on the annual required inspection.

The requested increase in capacity is approved effective today, 11/17/22
Exit interview conducted with Galina Komarova
Notice of Site Visit was provided and musty be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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