304314462-1-23-2025-06-CC-ANUZ-DD7RCV-20250123115458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314462
Report Date: 01/23/2025
Date Signed: 01/23/2025 11:55:17 AM

Document Has Been Signed on 01/23/2025 11:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	IVANCHUK, IVAN		FACILITY NUMBER:	304314462
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 6	CENSUS: 2	DATE:	01/23/2025
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:11 AM
MET WITH:	Lincensee, Ivan Ivanchuk		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Nunez conducted a case management inspection, in response to licensee’s request for a capacity increase from Small Family Childcare Home to Large Family Childcare Home. LPA met with licensee Ivan Ivanchuk who provided care and supervision to 2 preschool age children. Also present was licensee’s 2 adult assistants. Licensee stated there is currently 2 adults including the licensee and no minor children living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes are made to notify the licensing office. Facility Day care hours are 8:30 AM - 5:00 PM, Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This is a 2-story home, the following areas are upstairs: 3 bedrooms, 3 bathrooms, and a laundry room. The following areas are downstairs: 1 bedroom, 2 bathrooms, a living/dining rooms, kitchen, front yard (fenced), back yard (fenced), and garage. There is no fireplace in the home. The licensee acknowledged the children may never enter the off-limit areas during operation hours. Control of property was verified by LPA during today’s inspection. The licensee has a cell phone that is used for childcare. The licensee was informed if a cell phone is used for childcare, it must remain on the premises at all times during hours of operation. The licensee was informed and understands the home is to be free from smoking during hours of operation. Page 1 of 4

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IVANCHUK, IVAN	FACILITY NUMBER: 304314462
	VISIT DATE: 01/23/2025

NARRATIVE

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Areas Designated for Day Care Activities: Licensee has designated the back yard (fenced), living/dining room, the bedroom downstairs, the bathroom that’s inside the downstairs bedroom, and the bathroom that is next to the garage, as the day care areas.

Upon arrival parents enter the home through the front entrance to drop off the children in the day care area.

The designated Child Care areas were observed to have age-appropriate toys and educational items.

Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Poisons and Hazardous items were not observed. There are no bodies of water. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. Licensee stated there are no weapons or firearms on the premises. When firearms are present, they must be locked and stored separately from the ammunition.

During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged.

Outdoor play activities will be conducted in the backyard, which is appropriately fenced. LPA observed play equipment to be safe and free of hazards.

Per licensee, they provide meals/snacks to the children. LPA reminded licensee, container shall be labeled with child’s name and properly stored or refrigerated.

Per licensee, children nap in cots in the downstairs bedroom. LPA also observed a play yard in the bedroom.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IVANCHUK, IVAN	FACILITY NUMBER: 304314462
	VISIT DATE: 01/23/2025

NARRATIVE

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The licensee Pediatric CPR/First Aid certification expired 2/16/2026. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, 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. Proof of immunization against pertussis, measles for licensee and 2 adult assistants were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.

Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance.

The licensee has a current roster of children in care. During this inspection, LPA reviewed five children’s records and they were in compliance.

LPA advised the licensee how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov

LPA discussed the safe sleep regulations with facility representative 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 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.

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: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IVANCHUK, IVAN	FACILITY NUMBER: 304314462
	VISIT DATE: 01/23/2025

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded that all adults 18 and over, 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 Child Care Family 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.

During todays’ inspection, there were no deficiencies cited and licensee was in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

Fire clearance was received on 1/16/2025. A license with the change in capacity for 12 children (Large Family Childcare home) will be issued after final review and management approval.

Exit interview conducted and report was reviewed with the licensee Ivan Ivanchuk. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

End of Report

Page 4 of 4

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC809 (FAS) - (06/04)

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