195700043-4-26-2023-58-CC-AALA-CR9QY3-20230426123428

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700043
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:34:42 PM

Document Has Been Signed on 04/26/2023 12:34 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	BOIKO FAMILY CHILDCARE		FACILITY NUMBER:	195700043
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	04/26/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:23 AM
MET WITH:	Applicant Roksolana Boiko		TIME COMPLETED:	12:50 PM

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On 04/26/23 at 8:38 AM, Antonio Almanza, Licensing Program Analyst (LPA), conducted an announced Prelicensing visit. LPA met with Roksolana Boiko, applicant and applicants Spouse, who guided the LPA on a tour of the home. The applicant is applying for a small family Child Care License to operate Monday through Friday from 8:00 AM to 6:00 PM and provide services to children ages 2 years to 6 years old.

The home is a single-story home with attached garage. The home has 3 bedrooms, 2 bathrooms, living room, den, office, laundry room and kitchen. Parents will use the front door to drop off and pick up children in care. Children in care will use the living room, den, and bathroom #1 located in the hallway between rooms #1 and room #2. The garage, kitchen, laundry room, all bedrooms, office and bathroom located in bedroom #3 will be off-limits to children in care. There is a child safety gate in the entrance to the kitchen and front entrance area that leads to the hallway of the home.

There is a 2A10BC fire extinguisher or larger on the wall of the entrance of the home, purchased on 04/01/23. There is an operating combination Smoke/CO alarm in all the rooms and kitchen. The applicant places all sharp items, knifes in kitchen drawer with child safety latch. Applicant has a first aid kit in kitchen drawer. Medications will be kept away from children in the applicant’s bedroom. Applicant has 6 cots for children in care.

Cleaning supplies are kept in bottom kitchen cabinet with safety latch inaccessible to children. There is a fireplace in the living room that has been removed from service and covered and made to look like a playhouse.

LPA observed safe toys and play equipment age appropriate for childcare. The home is clean and orderly with central AC/Heating and ventilation for safety and comfort. Applicant will use cell phone for the childcare and was reminded that the cellphone must always remain in the home when children are in care. During the visit LPA did not observe any weapons or firearms; applicant states there are no weapons or firearms in the home.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BOIKO FAMILY CHILDCARE	FACILITY NUMBER: 195700043
	VISIT DATE: 04/26/2023

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The Applicant will use the back yard for children in care. The left side of the home and front yard will not be used by children in care. There is artificial turf along the length of the back yard and a concrete slab right outside the den door with covering above. There is canopy sail style covering over a large wooden play structure. The back yard is surrounded by wooden fence at least 6 feet tall. On the right side of the home there are two large metal gates that lead to the back yard.

The following was discussed with the applicant:
· Applicant was reminded that the applicants 2 children ages 3 months and 3 years will be considered part of the facilities ratios during hours of operation.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
· Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
· A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
· Changes should be reported the to the Department as soon as they occur such as construction and remodeling.
· Telephone number changes and/or if you move from home.
· Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BOIKO FAMILY CHILDCARE	FACILITY NUMBER: 195700043
	VISIT DATE: 04/26/2023

NARRATIVE

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· There is no smoking in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· Saucer chairs, bouncers, walkers, or any similar items are prohibited.
· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Website: www.mandatedreporterca.com
· Pediatric First Aid and CPR must be completed every 2 years.

The applicant was informed of the Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email: childcareadvocatesprogram@dss.ca.gov

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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 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.
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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BOIKO FAMILY CHILDCARE	FACILITY NUMBER: 195700043
	VISIT DATE: 04/26/2023

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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, licensee, or facility representative] 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.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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.

Prior to Licensure the following is required, and the applicant will complete by 05/01/23.

1. Update Facility Sketch
2. Anchor play structure to ground to keep it from wobbling.
3. LPA to verify that Facility File is complete with all required documents.
4. Licensing Program Manger Approval.

Exit interview conducted and report was reviewed with the applicant Roksolana Boiko.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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