274416254-9-14-2022-07-CC-JMAS-CJ9UKF-20220914153903

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416254
Report Date: 09/14/2022
Date Signed: 09/14/2022 03:39:37 PM

Document Has Been Signed on 09/14/2022 03:39 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MATROSOVA-KHALIL, SOFIA		FACILITY NUMBER:	274416254
ADMINISTRATOR:	SOFIA MATROSOVA-KHALIL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 277-4352
CITY:	SEASIDE	STATE: CA	ZIP CODE:	93955
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	09/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:03 PM
MET WITH:	Sofia Matrosova-Khalil		TIME COMPLETED:	03:50 PM

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Licensing Program Analyst (LPA) Joe Macias conducted an unannounced Required - 1 Year Inspection (care tool). LPA was greeted and granted entrance by the Licensee Sofia Matrosova-Khalil. The purpose of today’s inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Todays census is 2, (2 infants). The Licensee her mother Valentina Matrosova, as well as adult daughters Leila and Nadia Khalil are the only adults who reside in the home. The day care hours of operation are Monday - Friday, 8am - 5pm. The Licensee's CPR and First Aid are current and expire September 2024. The Licensee's fees are not current. The LPA reviewed the importance of remaining current on all annual fees. LPA explained the failure of a Licensee to pay all applicable and accrued fees and or civil penalties shall constitute grounds for denial or forfeiture of a license.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's visit. The last fire disaster drill was conducted on August 31, 2022. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. The home is orderly, and safe for the day care children. The LPA observed a securely barricaded fireplace in the home. LPA did not observe a wall heater in the home (central heat). Off limit areas of the home: all bedrooms, and back yard. The children have designated area in the home.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke, and carbon monoxide detectors. LPA Macias did not observed a body of water present. The Licensee states that she does not have weapons in the home. All detergents, cleaning compounds, poisons, medications, and other similar items are out of reach and inaccessible to children. Licensee states that she does not administer medications at this time. LPA reviewed the RAST procedure with the Licensee.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours to ensure that the children are safe and supervised at all times. The Licensee understands the current capacity options and she understands that she cannot have more than 14 children in the home at any time, with a qualified Assistant present. LPA provided the Licensee with the ratio/capacity chart for his reference. The Licensee states that she does not transport children; however she understands that children cannot be left in parked vehicles unattended any time.

LPA observed staff immunization records on file.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MATROSOVA-KHALIL, SOFIA	FACILITY NUMBER: 274416254
	VISIT DATE: 09/14/2022

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LPA discussed the safe sleep regulations with the License 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 licensee [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.

A review of staff records on September 14, 2022 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee Sofia Matrosova-Khalil 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.

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

The Licensee has completed the Mandated Reporter Training.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies cited. Exit interview conducted and report was reviewed with the Licensee Sofia Matrosova-Khalil.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

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