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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624923
Report Date: 04/27/2023
Date Signed: 04/27/2023 10:12:14 AM

Document Has Been Signed on 04/27/2023 10:12 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:NIKOLAEVA, ELENAFACILITY NUMBER:
343624923
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/27/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Elena NikolaevaTIME COMPLETED:
10:30 AM
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On April 27, 2023 at 8:30 AM, Licensing Program Analysts (LPAs) Tanya Washington and Eduardo Barragan met with Applicant Elena Nikolaeva for the purpose of a scheduled pre-licensing/ change of location inspection. Also present in the home is Licensee's husband Ivan Nikolaev Applicant was previously licensed at #343624089. All adults residing in the home have obtained required fingerprint clearances. The hours of operation will be Monday to Friday 7:00 AM to 7:00 PM. The visit was conducted in Russian language. Control of property is verified and a copy is the facility.

LPAs and Applicant conducted a tour of the entire home inside and out for health and safety hazards. This facility is a single story home which contains three bedrooms, two bathrooms, kitchen, living room, garage, laundry room and a fenced backyard. The off limit areas will include: garage, laundry room, part of the backyard which is fenced off by a chain link fence, master bedroom/ bathroom and Applicant's daughter's room (last two rooms in the hallway). 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. There is a fireplace in the living room which is properly screen, Applicant stated that it will not be used during day-care hours. 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 LIC809-C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: NIKOLAEVA, ELENA
FACILITY NUMBER: 343624923
VISIT DATE: 04/27/2023
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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 immunizations. Applicant and her spouse are both CPR and First Aid certified, the certificates are valid until 12/2024. 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. Applicant also understands that she is required to have a crib or a playpen for all infants under two years old.

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 is exempt from Mandated Reporter training due to language barrier, however she was advised to contact Child Action for available training in her language.

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, 04/27/2023, 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: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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