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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000536
Report Date: 05/03/2024
Date Signed: 05/03/2024 04:46:14 PM

Document Has Been Signed on 05/03/2024 04:46 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NIKCHEMNY, VIKTORIYAFACILITY NUMBER:
384000536
ADMINISTRATOR/
DIRECTOR:		NIKCHEMNY, VIKTORIYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 317-5880
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
05/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Yelyzaveta Demura, Oxana Chzhen and Anastasia StryukTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On May 3, 2024, licensing Program Analysts (LPAs) Van and Basak conducted a required inspection and met with the Licensee’s helper, Demura Yelyzaveta, who informed LPAs that the Licensee, Viktoriya Nikchemny, had a doctor's appointment. LPAs explained the purpose of the inspection to the helper and were granted access to the home. Inside, LPAs observed the children were napping, with two helpers supervising 11 children (two infants and nine preschoolers). The facility was found to be in full compliance with the licensing capacity and limits on this day.

All the adults present during the inspection have been confirmed to have cleared criminal clearance through the CDSS Guardian site. During the inspection, the licensee's adult daughter, Anastasia Stryuk, arrived to assist with the inspection. It is worth noting that the licensee's daughter has a large Family Child Care Home license at a different location. Additionally, the licensee arrived home during the visit.

There are no changes to the childcare areas previously approved, with the same off-limits and childcare areas. The childcare areas are on the ground level, including a nap room, two playrooms, a bathroom, and a backyard. The off-limit areas are the entire second floor and the garage. Days and operation hours are 8:00 am – 6:00 pm, Monday – Thursday, and 8:00 am – 5:00 pm on Friday. All off-limit areas are appropriately barricaded.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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Document Has Been Signed on 05/03/2024 04:46 PM - It Cannot Be Edited


Created By: Brendon Van On 05/03/2024 at 03:33 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPAs noticed that two infants were sleeping in play yards with bed sheets that were not properly secured or were loose, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 05/17/2024
Plan of Correction
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The Licensee must ensure and adhere to the infant's safe sleep regulations by keeping loose objects and using tight-fitted bedsheets. The licensee states that she will purchase fitted bedsheets and replace them by the due date. A return visit might be necessary to ensure the deficiency has been corrected.
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 the record review, the Licensee did not comply with the section cited above. The Licensee has not completed the training or has the certificate available for review, which poses/posed a potential health, safety, or personal rights risk to persons in care. In addition, two of the helpers have completed the required mandated reporter training, but their certificates have the same identification/certificate number. Further reviewing the mandated reporter certificates provided by the helpers is required to ensure compliance with regulations.
POC Due Date: 05/17/2024
Plan of Correction
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The Licensee must ensure that the Mandated Reporter Training is completed every 2 years and available for review during the inspection. The Licensee will submit a valid certificate of completion by 5/17/2023. A return visit might be necessary to ensure the deficiency has been corrected.
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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024


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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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536
VISIT DATE: 05/03/2024
NARRATIVE
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LPAs inspected the childcare areas for any potential dangers to health and safety hazards. LPAs observed that the childcare areas were clean and in good condition. There were age-appropriate toys such as imaginative, creative, and manipulative play. The home has appropriate heating, lighting, and ventilation, and no potential hazards could endanger children in care. Fireplace was observed barricaded. The Licensee had a fully charged fire extinguisher that met the minimum standard of 2A 10 BC and a carbon monoxide and smoke detector. A functional phone was also available in case of emergencies.

During the nap room inspection, LPA noticed a concerning issue. Some play yards had loose and not properly secured bedsheets, and two infants were found sleeping on two of these loosely fitted bedsheets. It is worth noting that discussions and reviews on the regulations regarding safe sleeping for infants were discussed and reviewed during the previous annual inspection. LPAs reminded the facility representative again that cribs or playpens must be completely free of toys, blankets, or pillows. The padding and mattress used in the playpen must be designed to fit its dimensions, and a bed sheet must be securely fitted. Furthermore, the facility must ensure infant safety with 15-minute napping checks, documented consistently with the check dates and available for review.

All cleaning agents and detergents were stored safely out of children's reach. The facility representative confirmed that no firearms or weapons were present on the premises. LPAs did not observe baby walkers, bouncers, or similar equipment in the childcare areas, and the facility representative was reminded that smoking is prohibited in the family childcare home.

The backyard was fenced entirely with age-appropriate playthings and free from any hazards or debris that could pose a risk to the children in care. LPAs observed that soft mats were installed on the backyard floor to prevent accidental falls.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536
VISIT DATE: 05/03/2024
NARRATIVE
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All helpers present have maintained complete records and have met all the necessary licensing requirements, including completing required immunizations and maintaining a valid Pediatric CPR/First Aid certification. However, the Licensee did not have her mandated reporter training available. Also, two of the helpers have completed the required mandated reporter training, but their certificates have the same identification/certificate number. Further reviewing the mandated reporter certificates provided by the helpers is required to ensure compliance with regulations.

All the required posting documentation, such as the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist, have been placed in a prominent area for parents or representatives to review. According to the facility representative, regular fire and earthquake drills are conducted at least once every six months. The latest drills were completed on 11/14/2023.

The records of all the children who were present were reviewed. The facility maintains accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. These emergency documents contain information such as the child's full name, phone number, and the location of a parent or authorized person who may be contacted in an emergency. The records also contain the name and phone number of the child's doctor and the parent's permission for the licensee to consent to emergency medical care if needed.

The 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536
VISIT DATE: 05/03/2024
NARRATIVE
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LPAs discussed the safe sleep regulations with the facility representative and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the representative 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: www.ada.gov/childqanda.htm.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPAs reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NIKCHEMNY, VIKTORIYA
FACILITY NUMBER: 384000536
VISIT DATE: 05/03/2024
NARRATIVE
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The Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

See LIC 809D for deficiencies cited today.

During the exit interview, the LICENSEE, VIKTORIYA NIKCHEMNY, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. In addition, appeal rights were explained and provided to the licensee.

An exit interview was conducted, and the report was reviewed with the licensee, Viktoriya Nikchemny.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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