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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624087
Report Date: 10/12/2021
Date Signed: 10/12/2021 11:16:32 AM

Document Has Been Signed on 10/12/2021 11:16 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MIKHALCHUK, VERAFACILITY NUMBER:
343624087
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
10/12/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vera MikhalchukTIME COMPLETED:
11:30 AM
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On October 12th, 2021 Licensing Program Analysts (LPA) Jeremey McClain conducted a Pre-Licensing inspection with Licensee Vera Mikhalchuk. Licensee has applied for a change of location for her Small Family Child Care License. A health and safety inspection of the home was conducted.

The two-story home has an unfenced front yard, 6 bedrooms, 3 bathrooms, a living room, dining room, kitchen, garage, and fenced backyard. The off-limits areas in the home will be the upstairs, two bedrooms downstairs, the garage, and the laundry room. Off-limits areas will remain inaccessible to children by closed doors and or supervision.

The fireplace in the living room is appropriately barricaded to prevent access by children. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors, and a 2A10BC fire extinguisher were observed in the home. Current pediatric CPR and first aid training was verified. Applicant stated there are no weapons in the home. No standing bodies of water were observed at the home.

Applicant has provided proof of Immunization for Pertussis, Measles and Influenza. Tuberculosis clearances for all adults in the home have been provided.

Applicant has completed the required AB1207 Mandated Reporter training. Applicant understands that the training must be completed once every two years, and that Mandated Reporter trainings offered outside of http://childcare.mandatedreporterca.com/ , must be approved by the department.

All individuals subject to criminal background review have obtained a criminal record clearance.

LPA advised applicant that 100% supervision is required in areas outside of the home that are unfenced.
REPORT CONTINUED ON THE FOLLOWING PAGE
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
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: MIKHALCHUK, VERA
FACILITY NUMBER: 343624087
VISIT DATE: 10/12/2021
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LPA explained to applicant that if they move and want to continue to provide care, they must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.

Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area.

LPA observed Licensee’s areas for postings. Licensee stated that she does not currently have Liability insurance, and she is aware that clients must sign LIC form 282. Applicant understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to three years after the child is no longer enrolled.

LPA discussed Safe Sleep regulations for homes. LPA provided applicant with a copy of the Infant Sleeping Plan (LIC 9227) and encouraged applicant to view the following website for more information:
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

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

This facility evaluation report was reviewed and discussed with the licensee.

Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Licensee’s request to change the location of her Small Family Child Care license is approved. Licensee can serve a capacity of 6 children with no more than 3 infants, or 4 infants only; or up to 8 children with no more than 2 infants, with 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC809 (FAS) - (06/04)
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