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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313985
Report Date: 03/03/2022
Date Signed: 03/08/2022 04:33:51 PM

Document Has Been Signed on 03/08/2022 04:33 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:SHATERNIK, VALDYSLAVFACILITY NUMBER:
304313985
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Applicant Mr. Shaternik, Valdyslav TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an announced in-person Pre-Licensing inspection for a new Small Family Child Care home. LPA met with the applicant Mr. Shaternik, Valdyslav who provided a tour of the new home.

A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared.
Applicant stated, he is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office.

The applicant is requesting a Small family childcare home license. Per applicant, operation hours will be Monday to Friday 8:30 AM to 5:30 PM and care and supervision shall be provided to children ages 1 to 10 years only .
All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story home with 3 bedrooms, 2 and a half bathrooms, living area, kitchen, dining area, family room, additional Sun room in the back yard with an attached garage. (Laundry area is in the garage)

Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone is the primary contact phone. Ventilation and heating. The home has a central air and heating system and the unit is installed in the side yard, area inaccessible to children. There is a stairway in the home, leading to the second level with a child safety gate installed at the bottom and there are two fireplaces with the required barriers (wooden book shelf) in front of the fire place.

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. (1)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHATERNIK, VALDYSLAV
FACILITY NUMBER: 304313985
VISIT DATE: 03/03/2022
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Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant has designated kitchen/ additional sun room, part of back yard and garage on the first level of the home, along with second level with three bedrooms and two full bathrooms as off limits areas to the children.

The applicant has installed a child safety gate in front of the kitchen on one side, while the other side has a wooden door which remains locked and the key is hanging on the top, where the children cannot reach. The additional sun room in the back yard is also locked. The second level is made inaccessible by installing a child safety gate at the bottom of the stairway. There are two fire places in the designated day care areas. Applicant has placed a wooden book shelf in front serving as barrier in the living area, while the fire place in the napping room has been covered with a wooden board installed over it, serving as a barrier.

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked.

The applicant shall use the Cell phone for Day care activities and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation. Applicant was informed and understands the home is to be free from smoking during hours of operation.



Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Applicant has designated the living room (Play room), family room is turned into a Napping room with 8 rolling beds, one half bathroom, dining area in front of the kitchen and the open back yard for Day care activities.

Applicant has set up the play room into several activity stations and all the posters and communication boards are printed in the cultural language. Children are offered Educational and recreational activity in this area. Family room has been designated as a Napping room, it has 8 rolling beds with mattress, linens and blankets. Dining area has a age appropriate dining table and chairs. Applicant shall serve home cooked meals and snacks to the children.

The designated Child Care rooms were observed to have age appropriate toys, arts and craft materials, books and educational items including age appropriate furniture.

No Infant care is being provided by the applicant. (2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHATERNIK, VALDYSLAV
FACILITY NUMBER: 304313985
VISIT DATE: 03/03/2022
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Applicant follows the CDC guidelines and children are encouraged to frequently wash their hands.

The bathroom is located on the left side in the napping room. There is a cabinet under the sink where additional paper products are stored. Applicant has age appropriate toilet seats/ potty chairs and step stool for easy access. The children's bathroom was observed to be safe and free of hazardous items.

OUTDOOR PLAY AREA: Applicant have designated the back yard for outdoor activities. It was observed to have age appropriate activities, there is swing play set included. There are additional outdoor toys arranged on the side. Part of the back yard is made inaccessible by installation of a fencing with a locked gate.

There are no firearms, weapons, or bodies of water in the home.

Applicant has one pet cat , it remains in the off limit area on the second level of the home.

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. Applicant has mounted one Fire extinguisher on the kitchen wall and second one is in the closet next to the main entrance door.



Applicant have completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 12/11/2023 There are first aid supplies available. First aid kit is stored in the closet.

The following was discussed with the applicant:·Applicant Mr. Shaternik, Valdyslav 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.

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, TB clearance along with a valid criminal record clearance associated to the facility license.

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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHATERNIK, VALDYSLAV
FACILITY NUMBER: 304313985
VISIT DATE: 03/03/2022
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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.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
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

Safe Sleep

LPA discussed the safe sleep regulations with Applicant Mr. Shaternik, Valdyslav 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 Mr. Shaternik, Valdslav 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.

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To receive important license -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.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: SHATERNIK, VALDYSLAV
FACILITY NUMBER: 304313985
VISIT DATE: 03/03/2022
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LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

LPA reviewed with applicant Mr. Shaternik, Valdyslav 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.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements.



LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

The facility at the time of Pre-licensing inspection is in compliance for a (Small Family Child Care Home) with Title 22 Regulations.


License shall be issued upon Management approval.

Exit interview conducted with the Applicant Mr. Shaternik, Valdyslav this report was read to the applicant.

Appeal rights were presented.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC809 (FAS) - (06/04)
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