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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622802
Report Date: 03/02/2022
Date Signed: 03/02/2022 12:32:30 PM

Document Has Been Signed on 03/02/2022 12:32 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:BILIK, MIKHAIL AND SHTEZEL TAMARAFACILITY NUMBER:
343622802
ADMINISTRATOR:SHTEZEL TAMARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 212-4144
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Olena KurusTIME COMPLETED:
12:45 PM
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On Wednesday, March 2, 2022, at 10:45 AM, Licensing Program Analysts (LPAs) Tanya Washington and Lea Habtom conducted an unannounced Required 1 year annual inspection and met with Assistant Olena Kurus, also present in the home is another assistant Albina Guzizova. LPAs observed care and supervision of seven day-care children. The off-limit area include: Master bedroom/ bathroom and garage. Assistant acknowledged that children may never enter these off-limits area. Assistant stated there are no new residents in the home since licensure. The hours of operation are Monday through Friday from 8:00 AM to 5:30 PM. Shortly after LPAs arrival, Flora Bilik arrived and delivered some requested information and assisted LPAs with the remainder of the visit.

LPAs observed current CPR/First Aid certificate for Assistant Olena and Licensee Tamara. LPAs reviewed five children’s files. LPAs observed that there were no hazardous items accessible to children. There is no fireplace in the home. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe. There are no bodies of water or weapons on the premises. LPAs discussed current COVID guidelines with Licensee.

LPAs observed a current fire drill log and children’s roster. Proof of AB1207 mandated reporter training was observed for Licensee Tamara and Assistant Olena. LPAs explained that the OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. Licensee is aware that she has to renew it every two years.

Staff were 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 NEXT PAGE

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BILIK, MIKHAIL AND SHTEZEL TAMARA
FACILITY NUMBER: 343622802
VISIT DATE: 03/02/2022
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This facility does not currently provide Incidental Medical Services- IMS. 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.

LPAs provided Licensee the Safe Sleep PIN 20-24 CCP and Infant Individual Sleeping Plan (LIC 9227).
LPAs 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 as an additional resource. LPAs also informed staff 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.
LPAs checked facilities fees and confirmed that it is up to date.

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.
In the areas that were evaluated, no Tittle 22 deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Assistant, Olena Kurus and Flora Bilik.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
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