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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313624882
Report Date: 04/03/2023
Date Signed: 04/03/2023 10:10:12 AM

Document Has Been Signed on 04/03/2023 10:10 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:DOLINA, ELENAFACILITY NUMBER:
313624882
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
04/03/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Elena DolinaTIME COMPLETED:
10:15 AM
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On April 3, 2023 at 8:00 AM, Licensing Program Analyst (LPA) Tanya Washington met with Applicant Elena Dolina for the purposes of a scheduled pre-licensing/ change of location inspection. Applicant was previously licensed at #343624882. All adults residing in the home have obtained required fingerprint clearances. The hours of operation will be Monday to Friday 7:00 AM to 6 PM. LPA and Applicant toured the entire home inside and out. There were two children present during today's inspection, Also present is Applicant's spouse and two children. The visit was conducted in Russian language. Control of property was obtained during the inspection.

LPA and Applicant conducted a tour of the entire home inside and out for health and safety hazards. This is a two story facility. The first floor has a living room, bedroom, bathroom, garage and kitchen. The second floor has three bedrooms, two bathrooms, laundry room and a loft. There is a fully fenced backyard which the Applicant will utilize for outdoor play. The off limit areas will include: entire second floor and garage. Applicant was notified that she would need to contact the department before making any on-limits areas to off-limits or vice versa.

All of the toxic or dangerous materials are inaccessible. The facility has a working telephone, fully charged fire extinguisher, first aid supplies, smoke detector, and carbon monoxide detector that meets regulations. As per the applicant, there are no firearms or weapons in the facility. All sharp objects and cleaning solutions are stored out of children's reach. LPA observed a gate at the bottom of the stairs barricading the second floor. Applicant understands that the gate must be installed whenever children under the age of five are present in the home. There is no fireplace in the home. There are no bodies of water on the premises.

Applicant 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.
Report continued on LIC812-C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: DOLINA, ELENA
FACILITY NUMBER: 313624882
VISIT DATE: 04/03/2023
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LPA discussed the licensing regulations, safe sleep procedures, and provided applicant with information on how to access PINs online at the CCLD website. Applicant has submitted record of all the required immunization, CPR valid. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. The applicant understands that baby walkers and smoking are prohibited within the facility.

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 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 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



Applicant has verification of Mandated Reporter training that she obtained through Child Action.

A copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request.


Effective today, 04/03/2023, the facility is licensed for a maximum of 6 children - no more than three infants or four infants only. 8 children no more than two infants and one child at least age 6 and one child enrolled and attending pre-kindergarten or elementary school.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
LIC809 (FAS) - (06/04)
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