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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314020
Report Date: 04/07/2022
Date Signed: 04/07/2022 02:42:58 PM

Document Has Been Signed on 04/07/2022 02:42 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, LUDMILAFACILITY NUMBER:
304314020
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/07/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Applicant Ms. Vilkin, Ludmila TIME COMPLETED:
03:00 PM
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Licensing Program Analyst's (LPA's) Ms. Desai Ketki and Ms. Torrence, Stacy conducted an announced in-person Pre-Licensing inspection for a new Small Family Child Care home.

It is a Relocation.

LPA's met with Applicant Ms. Vilkin, Ludmila 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. Operation hours will be Monday to Friday, 8.00 AM to 5.00 PM, care and supervision shall be provided to children ages 4-12 years old (Only School age).

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, she 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.

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. There is central air and heat in the home. Home has ceiling vents for air flow. The A/C unit is not accessible to children and it has a fencing in front making it inaccessible to children.

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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2022
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: VILKIN, LUDMILA
FACILITY NUMBER: 304314020
VISIT DATE: 04/07/2022
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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 two full bathrooms, loft area and a Laundry room. Third level of the home has a loft with a half 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 of the closed cabinet on the top. Per Applicant the school age children are aware not to enter the open kitchen area, and Applicant has child safety latches installed on it. During inspection no hazards were observed. Cabinet under the sink was observed to have only paper bags and no cleaning chemicals were observed. A/C unit is placed in the side yard with a safe wooden 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 area , Bedroom on the left side of the entrance is converted into the activity room where various activities are held. The day care area is spacious with Educational toys and items for the children. The designated bathroom is on the left 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.

Napping is in the designated bedroom the converted activity play room. Mats are used and linens and blankets are brought from home. Applicant is enrolled in the food program and does provide all food to the children. Children bring in their own personal water bottles and they are refilled . The bags are stored in their personal cubbies in the designated storage area next to the bathroom where personal cubbies are placed. Observed them to be safe with children's names and their individual bag packs are placed on the hanging hooks.

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, it has a table for Lego blocks, along with age appropriate toys there are several other outdoor educational activities ( Continued : Page 3)

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

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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: VILKIN, LUDMILA
FACILITY NUMBER: 304314020
VISIT DATE: 04/07/2022
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 it is shaded and safe for play. Back yard and side yard has artificial grass with safe fencing and shaded canopies, safe for outdoor play. Lunch table is also set up with in the back yard with a shaded canopy on the top.

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

Applicant does have a pet dog (German Shepherd: medium size) The pet shall remain in the off limit areas.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Applicant has mounted the Fire extinguisher on the wall, next to the bathroom . Home has three dual Smoke & Carbon Monoxide detectors.



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 8/9/2022. There are first aid supplies available.

The following was discussed with the applicant: 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.
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-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
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 Johnny jumpers, No Baby walkers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. (4)

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

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
Page: 3 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: VILKIN, LUDMILA
FACILITY NUMBER: 304314020
VISIT DATE: 04/07/2022
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Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

LPA discussed the following items with the applicant Ms. Vilkin, Ludmila during the Exit interview:

Criminal Record statement: Applicant Ms. Vilkin, Ludmila 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.

Safe Sleep : LPA discussed the safe sleep regulations with applicant Ms. Vilkin, Ludmila & 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 of the applicant Ms. Vilkin, Ludmila 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.

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.

Review of records to be maintained : LPA reviewed with applicant Ms. Vilkin, Ludmila 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.

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

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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: VILKIN, LUDMILA
FACILITY NUMBER: 304314020
VISIT DATE: 04/07/2022
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Subscribe to CCLD important information
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 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/process.


Exit interview conducted with the Applicant Ms. Vilkin, Ludmila this report was read to the applicant.

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.

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

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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