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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624534
Report Date: 03/30/2022
Date Signed: 03/30/2022 04:58:28 PM

Document Has Been Signed on 03/30/2022 04:58 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:OGANESOVA, NARINE FAMILY CHILD CAREFACILITY NUMBER:
376624534
ADMINISTRATOR:NARINE OGANESOVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 860-4055
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Nicole SnyderTIME COMPLETED:
05:15 PM
NARRATIVE
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On 3/30/22 at 12:50 PM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Annual inspection with the Licensee. Upon arrival, LPA met with Assistant Nicole Snyder who said that Licensee was at the doctor. Also, in the home was Assistant Svetlana Shakuto Lvovna and ten children in care. Licensee Narine Ogasenova returned to the facility at 2:00 PM. Proper supervision and ratios were observed. The three bedroom two bathroom single story home was toured and inspected to ensure an environment safe for the care and supervision of children. The 3A40BC fire extinguisher and combination carbon monoxide/smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee 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.

Licensee’s First Aid and CPR certifications expired on 2/18/2020. Licensee stated that she completed online CPR class recently but could not find her CPR/First Aid Card. Staff #1 First Aid and CPR certifications expire on 6/20/2023 and staff #2 CPR first aid certifications expire 7/3/2023. Licensee missing TB test, staff #1 missing MMR and staff #2 missing TDAP. Staff #1 completed Mandated Reporter Training which expires 6/14/2023. Licensee maintains emergency records for children. LPA reviewed 10 child records.
Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for
(continued on LIC809 page 2)
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 12
Document Has Been Signed on 03/30/2022 04:58 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/30/2022 at 03:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: OGANESOVA, NARINE FAMILY CHILD CARE
FACILITY NUMBER: 376624534

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as last disaster drill was 2/28/20 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2022
Plan of Correction
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Licensee states will conduct a fire drill and provide proof to LPA no later than close of business 4/27/22 and will in future conduct fire drills every six months.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above as Staff #2 and staff #3 have no mandated reporter certificates which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2022
Plan of Correction
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Licensee states that staff #2 and #3 will complete Mandated reporter training and supply certificate to LPA no later than close of business 4/27/22.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


LIC809 (FAS) - (06/04)
Page: 2 of 12
Document Has Been Signed on 03/30/2022 04:58 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/30/2022 at 03:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: OGANESOVA, NARINE FAMILY CHILD CARE
FACILITY NUMBER: 376624534

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above as staff #1 has no proof of MMR and there is no proof of TDAP staff #1 and no TDAP for staff #2 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2022
Plan of Correction
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Licensee states will provide proof of all required immunizations for staff #1 and #2 to LPA no later than close of business 4/27/22.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above as Licensee's CPR expired 2/18/2020 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2022
Plan of Correction
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Licensee states will complete EMSA approved CPR/First aid class and provide proof to LPA no later than close of business 4/27/22.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


LIC809 (FAS) - (06/04)
Page: 3 of 12
Document Has Been Signed on 03/30/2022 04:58 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/30/2022 at 03:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: OGANESOVA, NARINE FAMILY CHILD CARE
FACILITY NUMBER: 376624534

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above as staff 1 and 2 do not have complete immunizatrion records on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2022
Plan of Correction
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LIcensee states will provide proof of required immunizations for staff #1, #2 and #3 no later than close of business 4/27/22.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as child roster had not been updated to include several current childrenwhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2022
Plan of Correction
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Licensee states will provide updated roster to LPA no later than close of business 4/27/22.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


LIC809 (FAS) - (06/04)
Page: 4 of 12
Document Has Been Signed on 03/30/2022 04:58 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/30/2022 at 03:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: OGANESOVA, NARINE FAMILY CHILD CARE
FACILITY NUMBER: 376624534

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review the licensee did not comply with the section cited above as LIcensee does not have insurance and does not have LIC282 signed for 10 of 10 children in care which poses/posed a potential health, safety or personal rights risk to persons in care..
POC Due Date: 04/27/2022
Plan of Correction
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Licensee states will purchase daycare insurance or provide signed LIC282 forms for all children in care no later than close of business 4/27/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


LIC809 (FAS) - (06/04)
Page: 5 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: OGANESOVA, NARINE FAMILY CHILD CARE
FACILITY NUMBER: 376624534
VISIT DATE: 03/30/2022
NARRATIVE
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(LIC809 page 2)

child care include: living room, family room, bedroom at end of hall, hall and bathroom. Off limits areas include: kitchen, master bedroom, master bathroom, bedroom next to master bedroom, part of yard indicated on LIC999A, and garage and are inaccessible through use of gates, latches and locks. There is a working phone at the facility. Licensee reminded that facility phone must remain at facility during daycare hours or Licensee must obtain another phone. The licensee has sufficient age appropriate, safe, toys and equipment available. The home has a partially fenced backyard available for outdoor activities. Licensee advised that visual supervision rewuired at all times when children are outside.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances associated to the facility, corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Mangina reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA Mangina directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

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.

LPA discussed and provided 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
(continued on LIC809 page 3)
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
Page: 11 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: OGANESOVA, NARINE FAMILY CHILD CARE
FACILITY NUMBER: 376624534
VISIT DATE: 03/30/2022
NARRATIVE
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(LIC809 page 3)

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.

At 1:15 LPA observed that last Disaster drill was 2/28/20. At 2:00 PM LPA observed that 10 of 10 child files do not have LIC282. At 2:10 PM LPA observed that 9 of 12 children in care have not been added to roster. At 2:20 LPA observed no LIC508 for staff #2 and staff #3 and that staff #3 EMSA approved CPR/First aid is expired. At 2:25 LPA observed Staff #2 and staff #3 have no mandated reporter certificates. At 2:30 PM LPA observed no MMR for staff #1 and no TDAP for staff #2. 2:35 LPA observed immunization record for Staff 1, staff 2 incomplete.

See LIC809D’s for deficiencies cited and LIC9102s for Technical Violations given.

Exit interview conducted and report was reviewed with the licensee Narine Ogasenova. The Licensee was provided a copy of this report (LIC809). A Notice of Site Visit (LIC9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
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