343625640-4-23-2024-03-CC-TWAN-D4LQCJ-20240423120314

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625640
Report Date: 04/23/2024
Date Signed: 04/23/2024 02:42:21 PM

Document Has Been Signed on 04/23/2024 02:42 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:	TSYGANIUK, INNA		FACILITY NUMBER:	343625640
ADMINISTRATOR/ DIRECTOR:	TSYGANIUK, INNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 999-7906
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	04/23/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:45 AM
MET WITH:	Inna Tsyganiuk		TIME VISIT/ INSPECTION COMPLETED:	12:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On Tuesday April 23, 2024 at 10:45 AM, Licensing Program Analyst (LPA) Tanya Washington and Office Technician (OT) Yvonne Flores met with applicant, Inna Tsyganiuk for the purpose of a pre-licensing/ change of location inspection. Applicant is currently licensed under facility #343624973. The inspection was conducted in Russian language. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate 24 hours a day, seven days a week. Applicant understands that care may not exceed 24 hour period. Applicant owns the home and control of property was verified. Applicant has sufficient experience which qualifies her to operate at a large capacity of 14 children (when there is an assistant present). Applicants home was inspected by Sacramento Metropolitan Fire Department on 04/11/2024 and a fire clearance was granted. A health and safety inspection were conducted inside and out. This facility has three bedrooms, one bathroom, kitchen, living room, fenced front yard and fenced backyard with a shed. The off-limit areas of the home will be master bedroom and backyard. Applicant stated that children will utilize the fenced front yard for outdoor play and will be under direct supervision when playing outdoors. Off-limit areas will remain inaccessible to children by closed doors and/or supervision. Toxic and hazardous items are inaccessible to children. LPA observed a full 2A10BC fire extinguisher and functioning smoke and carbon monoxide detectors. Preventative Health, current pediatric CPR and first aid training was verified and expires 02/2025. Applicant stated that there are no weapons in the home. There is no fireplace in the home. Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards and around bodies of water. Immediate Civil Penalty regulation and deficiencies were reviewed. During the inspection of the backyard, LPA observed a spa which does not have a cover as required per Title 22 Regulations, although the spa is located on the property of 6737 Lincoln Ave, there is currently no fence separation between both yards. Continued on LIC809C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TSYGANIUK, INNA	FACILITY NUMBER: 343625640
	VISIT DATE: 04/23/2024

NARRATIVE

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA provided copies of forms for children's records.

LPA consulted applicant regarding the following topics; Type A vs. Type B deficiencies, complaints, LPA right to interview children without parental consent, civil penalties, incidental medical services, placement of detergents, placement of poisons, placement of medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, On-limits vs. Off-limit areas, licensing file management, fire drills, 80% supervision, 100% supervision, fingerprint clearances, advertising, mandated reporting best practices, and applicant’s responsibility to stay up to date on new law and regulations. Applicant is also advised that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

LPA consulted the applicant regarding personal rights. Applicant understands that corporal, physical and/or unusual forms of punishment is never allowed toward day care children or their own children during day care hours.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the applicant can obtain updated licensing information, new regulations and access forms. LPA advised applicant of their responsibility to stay current regarding new regulations.

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) or (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.

Continued on LIC809C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TSYGANIUK, INNA	FACILITY NUMBER: 343625640
	VISIT DATE: 04/23/2024

NARRATIVE

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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.
To receive important licensed-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.

LPA discussed the safe sleep regulations with applicant 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 Applicant 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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Applicant must comply with the following prior to becoming licensed:

- Remove spa from the premises or install appropriate cover with latches
- Post PUB394, LIC610A and LIC9148

After receipt of above items this facility will be granted a large license to serve a maximum capacity of 12 children (when there is an assistant present): with no more than 4 infants. or a maximum capacity of 14 children- no more than 3 infant. 1 child in kindergarten or elementary school and 1 child at least age 6.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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