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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618406
Report Date: 10/02/2024
Date Signed: 10/02/2024 04:05:26 PM

Document Has Been Signed on 10/02/2024 04:05 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:YUSHCHUK, TATYANAFACILITY NUMBER:
343618406
ADMINISTRATOR/
DIRECTOR:		YUSHCHUK, TATYANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 248-9499
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Tatyana YushchukTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) conducted an unannounced annual inspection and met with Licensee, Tatyana Yushchuk. LPA observed 8 children in care with licensee, none of whom are school aged and no assistant present. Cleared assistant arrived at the facility after about 15 minutes, putting licensee back in compliance. All individuals subject to criminal background review have obtained a criminal record clearance. Facility hours of operation are Monday to Friday from 7:00AM - 9:00 PM. LPA observed that the annual facility fees are current.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Off-limit areas include: Laundry Room and Garage. Licensee acknowledged that children may never enter these off-limit areas. The fireplace is barricaded. LPA conducted a health and safety inspection in the areas accessible to children and observed that the facility is in good repair and free of hazards with heating and ventilation for safety and comfort. The facility has equipment and age-appropriate materials for children. LPA observed the required documents were posted where visible to parents. LPA observed that there were no hazardous items—such as cleaning compounds, medications, or sharp objects that are accessible to children. The 2A-10-BC fire extinguisher appeared to be in working condition and is accessible. LPA observed the smoke and carbon monoxide detectors are functioning. Licensee stated there are no weapons/firearms on the premises. The backyard is fenced, and licensee acknowledged that in areas that are not fenced, 100% supervision is required. LPA did not observe bodies of water on the premises.
continued on LIC809-C...
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YUSHCHUK, TATYANA
FACILITY NUMBER: 343618406
VISIT DATE: 10/02/2024
NARRATIVE
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LPA observed a current children's roster and fire drill log which was last conducted on 09/01/24. LPA reviewed sample of children’s files and observed required documentation. LPA observed the CPR/First Aid certificate was valid until 01/26. Mandated Reporter Training (MRT) certificate was valid until 08/26. Licensee was reminded that both CPR/First Aid and MRT Child Care portion must be completed every two years. LPA reviewed staff and facility files and observed the required documentation.

Licensee is aware of and practicing safe sleep regulations. As an additional resource, LPA discussed the safe sleep regulations with licensee 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. 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 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/.

Licensee was informed of the https://mychildcareplan.org/ a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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. LPA reminded licensee about the quarterly updates provided by the Childcare Advocates Program. 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.
continued on LIC809-C...
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YUSHCHUK, TATYANA
FACILITY NUMBER: 343618406
VISIT DATE: 10/02/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Based on today's inspection, a Type A Title 22 Deficiency has been issued on the attached LIC 809-D page. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

A Notice Of Site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 09/13/24. Licensee has been provided with appeal rights. Exit interview was conducted, report was reviewed with the licensee, Tatyana Yushchuk.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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Document Has Been Signed on 10/02/2024 04:05 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 10/02/2024 at 10:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: YUSHCHUK, TATYANA
FACILITY NUMBER: 343618406

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as LPA observed 8 children in care with licensee, none of whom are school aged and no assistant present, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2024
Plan of Correction
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Licensee stated she will comply with small family child care ratio when no assistant present, and if there's no school aged child, she will ask parents/guardians to wait until assistant is present before accepting more children in care. LPA will conduct a plan of correction visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


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