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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409789
Report Date: 05/07/2025
Date Signed: 05/07/2025 03:53:42 PM

Document Has Been Signed on 05/07/2025 03:53 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:STEFANETS, NATALIIAFACILITY NUMBER:
073409789
ADMINISTRATOR/
DIRECTOR:		NATALIIA STEFANETSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 727-2116
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 14TOTAL ENROLLED CHILDREN: 19CENSUS: 11DATE:
05/07/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Nataliia StefanetsTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 05/07/2025 at 1:00PM, Licensing Program Analysts (LPAs) Dana Santiago and Kareeca "Reeca" Sykes arrived at the home for an announced prelicensing, change of location, inspection. LPAs met with Nataliia Stefanets. Present during the inspection was applicant and two (2) adult assistants that are fingerprint cleared. Living in the home is the applicant, the applicant's spouse, and applicant's minor child. Eleven (11) day care children were present today (1 infant and 10 preschool aged).

Applicant stated the operating hours are 7:30AM-6:00PM, Monday to Friday.

LPAs toured the home with the applicant. The home is a one story house, which consists of the living room, dining room, kitchen, 3 bedrooms, 2 bathrooms, attached garage, backyard, and driveway. The home is neat and clean with heating and ventilation for the safety and comfort of children in care.

The on-limit areas: include the living room, dining room, bedroom 1, bedroom 2, bathroom 1,middle section of backyard.
The off-limit areas: include the applicant's bedroom ( bedroom 3), driveway, front yard, kitchen, hallway closet, bathroom 2 (located in bedroom 3), hallway closet, and the LEFT and RIGHT side of the backyard. These areas are made inaccessible by closed and/or locked doors, safety gates, and 100% visual supervision. The outdoor play area is the fenced backyard in the middle section. The isolation area will be the bedroom 1 (nap room), away from other children in care. Access to the backyard area is through the dining room.

See LIC809C for continuance on page 2---------------------------------------------------------------------------
NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Dana Santiago
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: STEFANETS, NATALIIA
FACILITY NUMBER: 073409789
VISIT DATE: 05/07/2025
NARRATIVE
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There is an ample supply of age appropriate toys and activities accessible to children, and LPAs observed that they are in good condition. There is a fully charged 2A10BC fire extinguisher, working carbon monoxide and smoke detector, telephone and fully stocked first aid kit. The fireplace is blocked, applicant states that they don't use it. LPAs did not observe any bodies of water, hazardous items or toxins accessible to children today. Per the applicant, there are no firearms or ammunition in the home. Applicant has current CPR and first aid certificates as well as required mandated reporter training.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

On this date, 05/07/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPAs 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-andresources/safe-sleep, as an additional resource. LPAs 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.

See LIC809C for continuance on Page 3----------------------------------------------------------------------------

NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Dana Santiago
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: STEFANETS, NATALIIA
FACILITY NUMBER: 073409789
VISIT DATE: 05/07/2025
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Applicant the rents the home and provided a copy of the lease. The capacity for the license will be listed as 14 children.

Fire clearance was granted on 4/23/2025.

Subscribe to CCLD important information - Family Child Care Homes: 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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

Before this license can be issued, the following pending corrections need to be completed:

  • fencing in backyard area needs to be replaced, repaired, or made inaccessible to children in care

Based on observations, interviews and information obtained throughout the inspection, LPAs determined that unlicensed care was being provided therefore violation of California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

Exit interview was conducted with applicant Nataliia Stefanets, report and appeal rights were reviewed and given to applicant.

NAME OF LICENSING PROGRAM MANAGER: Monica Mathur
NAME OF LICENSING PROGRAM ANALYST: Dana Santiago
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 05/07/2025 03:53 PM - It Cannot Be Edited


Created By: Dana Santiago On 05/07/2025 at 02:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: STEFANETS, NATALIIA
FACILITY NUMBER: 073409789

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.61(a)


This requirement is not met as evidenced by: LPAs conducting a prelicensing, relocation inspection and observing the applicant and applicant's fingerprint cleared assistants providing unlicensed care for 11 children.
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above by providing unlicensed care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2025
Plan of Correction
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Facility must ceased and desist providing care for children as of COB 5/7/2025. Nataliia Stefanets MUST submit a written statement that the regulations are understood and will not provide care until license is issued. Failure to comply with licensing's decision will result in a $200/day civil penalty.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Monica Mathur
NAME OF LICENSING PROGRAM MANAGER:
Dana Santiago
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2025


LIC809 (FAS) - (06/04)
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