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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624087
Report Date: 10/14/2022
Date Signed: 10/14/2022 01:21:27 PM

Document Has Been Signed on 10/14/2022 01:21 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:MIKHALCHUK, VERAFACILITY NUMBER:
343624087
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
10/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Vera MikhalchukTIME COMPLETED:
01:35 PM
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On 10/14/22 Licensing Program Analysts (LPAs) Fabiola Diaz and Carla Polanco met with licensee Vera Mikhalchuk for an unannounced annual/1 year inspection. During the inspection there were 2 of licensee's own children. All individuals subject to criminal background review have obtained a criminal record clearance. Licensee explained that she currently does not have day care children enrolled.

The home is a two story home with a front yard, 6 bedrooms, 3 bathrooms, kitchen, family room, living room, garage, laundry room, and a backyard. The off-limit areas are: entire second floor, garage, laundry room, bedrooms #1 and 2, and sides of backyard. Licensee was notified that prior to any changes of an on-limit to an off-limit area, or vice versa, the department must be notified. LPAs observed the fire place to be screened.

A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet Title 22 regulations. Licensee stated there is no firearms on premises. LPAs observed all the required postings. LPAs advised the licensee that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

LPAs observed licensee's immunization records at office file. LPA printed out a list of documents required to keep at the home for adult assistants and adults residing in the home. LPAs discussed maintaining a children's roster and a fire drill log. Licensee's CPR/First aid card had an expiration date of 9/23. Mandated Reporter Training for licensee was not observed. Licensee stated she will enroll in the Russian class at the Resource and Referral agency. A technical assistance note was provided. Licensee understands these trainings must be completed every two years. LPA provided licensee with an updated LIC311D.
Report continues on 809C...............
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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: MIKHALCHUK, VERA
FACILITY NUMBER: 343624087
VISIT DATE: 10/14/2022
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Incidental Medical Services were discussed– IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
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 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.

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.

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 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.

Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days. Exit interview was conducted and report was reviewed with the licensee.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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