304313898-6-23-2021-06-CC-KDEI-C49QAT-20210623120028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313898
Report Date: 06/23/2021
Date Signed: 06/23/2021 12:00:48 PM

Document Has Been Signed on 06/23/2021 12:00 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	VILKIN, VIKTORIA		FACILITY NUMBER:	304313898
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/23/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ms. Vilkin, Viktoria		TIME COMPLETED:	12:30 PM

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Licensing Program Analyst (LPA) Ketki Desai conducted an announced in-person Pre-Licensing inspection for a new Small Family Child Care home. LPA met with Applicant Ms. Vilkin, Viktoria who guided analyst on a tour of the new home. The home is a three story home, with a stairway inside the home. The Applicant is requesting a Small family childcare home license. Operatng hours will be Monday to Friday, 8.00 AM to 6.00 PM, care and supervision shall be provided to children ages 18 months to six years old.
LPA observed applicant following CDC and Dept of Public Health Guidelines.

At the time of inspection today, there was no one present in the home.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a three story home with Four Bedrooms/ Five full bathrooms, Living room, Kitchen with dining area, Loft on the third level with open balcony area , laundry room and garage. Covered side patio with side yard and a back yard accessible to children through the dining area.

A review of the Facility Personnel Report Summary indicates all the adults residing in the home are cleared, who require caregiver background check clearances exemptions. Licensee stated she is not registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office.

Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air and Heating system, and A/C unit is installed in the side yard with a safe barrier covering. The home also has a sprinkler system installed.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VILKIN, VIKTORIA	FACILITY NUMBER: 304313898
	VISIT DATE: 06/23/2021

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Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The Applicant states (that there are no poisons on the premises).Applicant was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: There is a stairway in the home leading to the second and third level of the home. Applicant has installed a child safety gate making the upper levels of the home inaccessible. Second level has three bedrooms/ with three full bathrooms and a laundry room. Third level of the home is a loft (open living area) with full bathroom and open balcony area. Applicant has the garage entrance on the first level, it is inaccessible, applicant has installed a double lock on the door. Kitchen is open, all the sharp objects are placed on the top shelf in a clear box inside a closed cabinet besides the refrigerator. All the other kitchen cabinets have a child safety stoppers installed and gas knobs have safe covers, making the open kitchen area safe. Cabinet under the sink also has safety stoppers. During inspection no hazards were observed. A/C unit is placed in the side yard with a safe metal barrier across it, making the area inaccessible. Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Children shall enter the home through the front door leading into the designated Day care area. Applicant completes temperature checks including hand sanitization upon entering into the designated Day Care area (Living room & Dining area) where the applicant has set up the Day care room with various educational and learning activities, bedroom on the right side of the entrance is converted into the Art room where Arts and Crafts activities are held. The day care area is spacious with Educational toys and items for the children. The designated bathroom is on the right end of the passage area. Designated children’s bathroom was observed to be safe and free of hazardous items. There is a cabinet under the sink, with no hazardous items and bathroom was clean.

Applicant stated napping shall be in the designated art room and mats shall be used, linens and blankets shall be brought from home and taken for wash on a weekly basis. Children shall bring in their own Lunch along with personal water bottles shall be refilled as needed. The bags are stored in their personal cubbies in the designated storage area next to the bathroom where personal cubbies are placed. Applicant shall provides snacks to children and water is refilled as needed.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VILKIN, VIKTORIA	FACILITY NUMBER: 304313898
	VISIT DATE: 06/23/2021

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OUTDOOR PLAY AREA: Per Applicant, children shall use the back yard area, covered side patio and side yard. The back yard is accessible through the sliding door from the dining area, side yard is adjoining to the backyard. Side covered patio is set up for outdoor activities with wooden toy home structure and various educational outdoor toys including a table for water and sand play. The floor has soft padded matting carpet along with awings on the top for shade. Out door area is safe for play with age appropriate activities. Lunch table is also set up with in the back yard with a shaded canopy on the top.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. The home has Sprinkler system also.

Applicants have completed the required Health and Safety with Nutrition and Lead Poisoning component Training and Pediatric First Aid and CPR which expires on 3/2023 There are first aid supplies available.

Per applicant there are no Pets, weapons or bodies of water in the home. The home was clean, orderly, and at a comfortable temperature.

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.
·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 Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license, along with TB test and Immunization record on file.

·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may 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 replaced as needed.

Licensee was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov (Page-3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VILKIN, VIKTORIA	FACILITY NUMBER: 304313898
	VISIT DATE: 06/23/2021

NARRATIVE

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Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: 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.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

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.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

UPDATE: H&S 1597.622: 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.
Applicant has submitted proof of immunization's.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms: All the forms were provided to the Applicant during the Pre-Licensing inspection today. (Page-4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VILKIN, VIKTORIA	FACILITY NUMBER: 304313898
	VISIT DATE: 06/23/2021

NARRATIVE

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A Packet with following forms were provided and discussed with the applicant during the Pre-Inspection today.

CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224).

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149).

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following: Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care 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 (Page-5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VILKIN, VIKTORIA	FACILITY NUMBER: 304313898
	VISIT DATE: 06/23/2021

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COVID 19 Self Assessment guide was reviewed and received from the applicant.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian.

A copy of the Provider Information Notice (PIN) 20-06-CCP Social and Physical Distancing Guidance and Healthy practices for childcare facilities in response to the global coronavirus (COVID-19) pandemic written in collaboration with the CA Department of Education. A copy of COVID-19 posters and Essential workers list.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

The facility at the time of Pre-licensing is in compliance for a (Small Family Child Care Home) with Title 22 Regulations. License shall be issued after management approval.

Appeal rights were presented and Exit interview was conducted with the applicant Ms. Vilkin, Viktoria.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

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