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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001202
Report Date: 06/20/2024
Date Signed: 06/20/2024 05:32:14 PM

Document Has Been Signed on 06/20/2024 05:32 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:PETROVA, TETJANAFACILITY NUMBER:
384001202
ADMINISTRATOR/
DIRECTOR:		PETROVA, TETJANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 242-5115
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
06/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Tetjana PetrovaTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On June 20, 2024., Licensing Program Analyst (LPA) Van conducted a required annual inspection and met the Licensee, Tetjana Petrova. LPA explained the purpose of the inspection to the Licensee and was given access to the home. Upon entering the house, LPA observed that some children were getting up, and the licensee was preparing snacks for the children. The licensee and a helper supervised nine children: three infants and six preschool-age children. The Licensee complies with the licensing capacity and limits today. All adults working or residing at the home have cleared criminal clearance verified with the CDSS Guardian background check system.

According to the licensee, the childcare areas previously approved remain the same, with the same off-limits and childcare areas. The Childcare areas are on the ground floor level, including the playroom, nap room, backyard, full bathroom, and half bathroom. The off-limit areas are the entire 2nd floor and the garage. All off-limits areas have been appropriately blocked off from the children. The operation hours are Monday through Friday from 7:00 a.m. to 6:00 p.m. The Licensee has valid childcare liability insurance on file.

LPA and the Licensee inspected the childcare areas for any potential dangers to health and safety hazards. LPA observed that the childcare areas were maintained clean and orderly. The spaces were furnished with age-appropriate toys, engaging reading materials, and activities to foster children's imaginative and cognitive development. The childcare areas have appropriate heating, lighting, and ventilation, and no potential hazards could endanger children in care. The Licensee had a fully charged fire extinguisher that met the minimum standards of 2A 10 BC, multiple carbon monoxide, and a smoke detector. A functional phone was also available in case of emergencies.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PETROVA, TETJANA
FACILITY NUMBER: 384001202
VISIT DATE: 06/20/2024
NARRATIVE
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There was no fireplace in the childcare area. The licensee mentioned that she has a dog that is always kept in the off-limits area. She also confirmed that the dog's vaccinations are up to date.

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

The backyard is fully enclosed and equipped with age-appropriate play equipment. It is clear of any dangers or clutter that could harm the children in my care. The licensee has placed a soft rug on the backyard floor to reduce the chances of accidental falls and injuries.

LPA noticed four play yards in the playroom. All play yards were observed free of toys, blankets, or pillows inside. The play yard paddings fit their dimensions, and the bedsheets were snugly secured. The 15-minute sleep logs for infants were checked, and it was noted that the licensee had accurately documented the logs, including the date, time, and staff initials.

The licensee and the assistant have kept thorough records and have fulfilled all the essential licensing requirements, including obtaining necessary immunizations and staying up to date with mandated reporter training. The licensee and the assistant hold a valid Pediatric CPR/First Aid certification.

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 licensee, regular fire and earthquake drills are conducted at least once every six months, with the most recent drills completed on 5/21/2024.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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: PETROVA, TETJANA
FACILITY NUMBER: 384001202
VISIT DATE: 06/20/2024
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The records of five random children who were present were reviewed. The licensee 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.

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.

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.

LPA discussed the safe sleep regulations with the Licensees 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. LPA also informed the 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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: PETROVA, TETJANA
FACILITY NUMBER: 384001202
VISIT DATE: 06/20/2024
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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.

LPA 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.

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.

During the exit interview, the LICENSEE, TETJANA PETROVA, 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.

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

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
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