075700246-12-9-2022-52-CC-JPLA-CLXU74-20221209141918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 075700246
Report Date: 12/09/2022
Date Signed: 12/09/2022 02:19:25 PM

Document Has Been Signed on 12/09/2022 02:19 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SOKOLOVA, VALERIIA		FACILITY NUMBER:	075700246
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/09/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Valeriia Sokolova		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On December 9, 2022 at 12:45pm, Licensing Program Analyst (LPA) Julia Placencia arrived announced for a Prelicensing Inspection. LPA met with applicant Valeriia Sokolova, and her daughter Yevheniya who served as translator. Also residing in the home is the applicant’s husband Ihor Sinkevych and two sons (ages 14 and 16 years). All adults have proper fingerprint clearances. The home was toured with the applicant and her daughter to conduct a health and safety inspection. Applicant states the hours of operation for day care will be Monday through Friday, 8:15am to 6:00pm. The home is single story, which consists of a kitchen, dining room, living room, family room, four bedrooms, two bathrooms, laundry room, garage and a backyard. The home is neat and clean with heating and ventilation for safety and comfort. ON LIMITS: Living room, family room, kitchen, dining room, hall bathroom, gated play area in backyard. The isolation area will be in the family room. OFF LIMITS: All bedrooms, master bathroom, laundry room, garage, backyard area beyond the enclosed gated play area. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits. The applicant’s preventative health and safety training has been completed, and includes the child nutrition and lead poisoning components. First Aid/CPR certificate is current, expiring on 2/13/24. A copy of the lease agreement has been reviewed and shows control of property. The applicant has provided proof of the required immunizations for daycare providers, and mandated reporter training was completed on 10/30/22. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed, and copies were left with the applicant. ***Continued on LIC 809C...

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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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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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: SOKOLOVA, VALERIIA	FACILITY NUMBER: 075700246
	VISIT DATE: 12/09/2022

NARRATIVE

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The outdoor play area will be the enclosed gated area in backyard. There is also a fence surrounding the perimeter of yard. LPA observed the yard is free from defects or dangerous conditions. There are ample age appropriate toys, inside and outside, which are observed to be safe, clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPA did not observe any hazardous materials or toxins accessible to children today. Knives and medications were stored in upper kitchen cabinets inaccessible to children. The home has a fully charged fire extinguisher located in hall closet, working carbon monoxide/smoke detector combination unit on the kitchen ceiling, telephone, and fully stocked first aid kit. The fireplace is screened and blocked by children's shelving. Heater vents are located on the floor and lower portion of walls which applicant has closed to prevent vents from getting hot. Per applicant, there are no firearms in the home.

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.

Applicant 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 $500.00 maximum per day/per person will be assessed if this regulation is violated.

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

***Continued on LIC 809C...

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: SOKOLOVA, VALERIIA	FACILITY NUMBER: 075700246
	VISIT DATE: 12/09/2022

NARRATIVE

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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.

This home is recommended for licensure today, 12/09/2022. This report shall remain on file for 3 years. Exit interview conducted and copy of report provided.

Exit interview conducted with applicant Valeriia Sokolova and copy of report provided.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained. A fire/disaster drill must completed at least every six months and must be documented. Mandated reporter requirements also discussed. Applicant received copies of various pamphlets pertaining to child's safety and parent's responsibilities. Informed the applicant that all forms can be downloaded at www.ccld.ca.gov.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC809 (FAS) - (06/04)

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