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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409362
Report Date: 01/10/2023
Date Signed: 01/10/2023 12:26:26 PM

Document Has Been Signed on 01/10/2023 12:26 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:SAFANIEV, NATALIEFACILITY NUMBER:
073409362
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/10/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Natalie SafanievTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Cherie Acosta met with applicant, Natalie Safaniev for an announced Prelicensing Inspection. Present during the inspection was the applicant, her fingerprint cleared son and daughter-in-law. Applicant states that the hours of operation will be 7:00am to 6:00pm Monday through Friday.
The home is a two story home. The entire home was toured for a health and safety inspection. The first floor consist of the living room, family room/child care room, kitchen, dining room, bedroom, 2 bathrooms, laundry room and garage. The second floor consist of three bedrooms and two bathrooms. The home is neat and clean with heating and ventilation for safety and comfort. The on limits area used for child care include the family room/child care room and bathroom nearest to the child care room. The remainder of the home is off limits to children. Off limits areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. There are age appropriate toys in the home. The fenced back yard will be used for outdoor play. The home has a pool. The pool is completely fenced to prevent access by children. The pool gate opens away from the pool and is self closing. The on limits area of the backyard is fenced off from the area were the pool is located. There is a pool house located in the off limits area of the backyard. The pool house is off limits to children. There are no firearms in the home as stated by the applicant. 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 fireplace is located in the off limits area of the home and is screened to prevent access by children. Gates are placed in the child care room and living room to prevent access to the off limits area of the home including the stairs.
The applicant has current CPR/First Aid which expires 10/24. Applicant completed mandated reporter training 11/8/22. Applicant is in compliance with required immunizations. A copy of the mortgage statement was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SAFANIEV, NATALIE
FACILITY NUMBER: 073409362
VISIT DATE: 01/10/2023
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LPA discussed the safe sleep regulations with applicant 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 applicant 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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

Prior to licensure applicant shall provide proof of completing EMSA approved preventative health and safety training. Exit interview and report reviewed with Natalie Safaniev.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
LIC809 (FAS) - (06/04)
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