343626200-11-13-2024-03-CC-TWAN-DAXSKB-20241112125628

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343626200
Report Date: 11/12/2024
Date Signed: 11/13/2024 08:55:16 AM

Document Has Been Signed on 11/13/2024 08:55 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	DMYTRYCHENKO, LILIIA		FACILITY NUMBER:	343626200
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	11/12/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Lilia Dmtrychenko		TIME VISIT/ INSPECTION COMPLETED:	01:20 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, November 12, 2024, at 12:00 PM, Licensing Program Analyst (LPA) Tanya Washington and Lea Habtom arrived at the facility and met with applicant, Lillia Dmtrychenko, for the purpose of a pre-licensing inspection. Applicant's husband and adult daughter were present in the home. The inspection was conducted in Russian language. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant stated she plans to operate Monday- Friday from 7 AM to 7 PM and other hours as arranged. Applicant's spouse is the home owner and control of property was verified. A health and safety inspection were conducted inside and outside. This facility is a one story home which has three bedrooms, two bathrooms, office, garage and fenced backyard. The facility has a fenced backyard which will be utilized for outdoor play. The off limit areas will consist of master bedroom, master bathroom, daughter's bedroom, office and garage. Applicant agrees that these areas of the home must be inaccessible to children by a closed door and or supervision. LPAs observed cleaning supplies under kitchen and bathroom sinks. LPAs observed a functioning smoke detector, however the facility does not have a carbon monoxide detector. Applicant did not have proper size fire extinguisher and stated that she will purchase one that is at least 2A10BC size or bigger. Preventative Health, current pediatric CPR and first aid training was verified and expires 8/2026 . Applicant is exempt from Mandated Reporter Training due to language barrier. Applicant was reminded to renew the CPR and First Aid training once every two years. Applicant stated that there are no weapons in the home. There is no fireplace in the home. Report continued on LIC809C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

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: DMYTRYCHENKO, LILIIA	FACILITY NUMBER: 343626200
	VISIT DATE: 11/12/2024

NARRATIVE

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Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards or around bodies of water. Immediate Civil Penalty regulation and deficiencies were reviewed. There are no bodies of water on the premises.

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.

LPAs reviewed with applicant and provided copies of all forms required for children's records including form LIC311D, Forms/Records To Keep In Your Family Child Care Homes, and information to be posted.

LPAs consulted applicant regarding the following topics; Type A vs. Type B deficiencies, complaints, LPA’s 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.

LPAs 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.

LPAs 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.
LPAs advised applicant to sign up for the quarterly updates provided by the Childcare Advocates Program.

Report Continued on LIC809C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

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: DMYTRYCHENKO, LILIIA	FACILITY NUMBER: 343626200
	VISIT DATE: 11/12/2024

NARRATIVE

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LPAs 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.

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.

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.

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.

Prior to licensure the following is required:
- Purchase a 2A10BC fire extinguisher
- Purchase and install carbon monoxide detector
- Make knifes and sharp objects located in a kitchen cabinet inaccessible to children
- Remove or make inaccessible cleaning supplies under both kitchen and bathroom sinks

Exit interview conducted and report was reviewed with the applicant, Lilia Dmytrychenko.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC809 (FAS) - (06/04)

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