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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000536
Report Date: 05/09/2024
Date Signed: 05/09/2024 04:59:43 PM

Document Has Been Signed on 05/09/2024 04:59 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: 14CENSUS: 11DATE:
05/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:50 PM
MET WITH:Viktoriya NikchemnyTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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On May 9, 2024., Licensing Program Analysts (LPAs) Van and Basak conducted a case management inspection in conjunction with the Plan of Correction (POC). LPAs met with the Licensee, Viktoriya Nikchemny. During today's case management meeting, LPAs discussed the issue of the mandated reporter training certificates that the licensee provided during the annual inspection on May 3, 2024. It was discovered that both helpers had the same certificate number on their mandated reporter certificate of completion.

After conducting a thorough investigation into the certificates, the Mandated Reporter technical support unit concluded that the certificate in question belonged to S1, whereas the certificate issued to S2 had been falsified. The Mandated Reporter technical support further explained that the system does not allow multiple users to access the system with the same email address. Furthermore, the system generates unique certificate numbers using a specific algorithm at the completion of the training, which cannot be reused or duplicated.

As a result, the following Title 22 deficiency was cited on the next page. Since, this was a repeating violation, a civil penalty of $250 was assessed.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report and appeal rights were reviewed with the licensee, Viktoriya Nikchemny.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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 05/09/2024 04:59 PM - It Cannot Be Edited


Created By: Brendon Van On 05/09/2024 at 04:13 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: 05/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2024
Section Cited
HSC
1596.8662(b)(1)

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(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:
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The helper will complete the mandated reporter training and submit the certificate of completion to the Licensing office no later than 5/17/2024. In addition, the Licensee must provide a written plan to address and prevent such incidents from reoccurring.
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Based on the record review, the Licensee did not comply with the section cited above. Upon further review and investigation by the Mandated Reporter technical unit, the S2 certificate was found to be falsified. As a result, S2 must complete and update the mandated reporter training. Not having a valid or taking the mandated reporter training as required could pose a potential health, safety, or personal rights risk to persons in care.
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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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2024


LIC809 (FAS) - (06/04)
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