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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001243
Report Date: 02/06/2025
Date Signed: 02/06/2025 12:31:57 PM

Document Has Been Signed on 02/06/2025 12:31 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GOLDFELD, GALINA & GOLDFELD, VLADIMIRFACILITY NUMBER:
384001243
ADMINISTRATOR/
DIRECTOR:		GOLDFELD, GALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 531-0018
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:53 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 02/06/2025, at approximately 8:50am, Licensing Program Analysts (LPAs) Badger and Van arrived at the facility to conduct an annual inspection. LPAs were granted entrance and met by Licensees, Galina and Vladimir Goldfeld, and two aides. LPAs explained the purpose of the inspection. Present in the facility were both Licensees and 2 Aide supervising 10 children (4 infant and 6 preschool age children). The facility is operating within capacity limits on this day. All adults living and working in the home are fingerprint cleared and associated, confirmed through a check on CDSS Guardian Background Check System.

The hours of the operation are from Monday - Friday, 8:00am - 5:30pm. DAY CARE AREAS: Ground floor, including the playroom, 2 bedrooms, 1 bathroom, and backyard.
OFF-LIMIT AREAS: Garage, the kitchenette and the entire second-level floor.

The backyard's ground is padded to prevent injuries. Play structures appear to be clean, safe and age appropriate.

LPAs inspected day care areas for health and safety hazards. LPAs observed home to be clean and in good condition. The air quality is comfortable is cool with proper temperature and ventilation. There were a variety of age-appropriate toys and equipment in the home which were in good condition. No fireplaces were observed in day-care areas. The Licensees have no pets in the home. There are no pools or bodies of water in the premises. All cleaning supplies, poisons and other chemicals were stored inaccessible to children. Discipline Policy was discussed. Infant children sleep in a pack and play, and preschool-age children sleep on age appropriate cots. All children sleep in the "nap room," located in the day-care area, under the supervision of the Aide and/or Licensee Galina. LPA reminded and discussed the Infant Safe Sleep regulations with the licensee, including the infant asleep log and documenting that you have checked on the sleeping infant every 15 minutes.

There was a fully charged fire extinguisher, smoke alarm and carbon monoxide alarm, and a working telephone on site. Phone number listed for Licensees are current. Per Licensees, there are no weapons or firearms in the home.

Continued on page 2..
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Jovanna Badger
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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 02/07/2025 09:56 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/07/2025 09:53 AM


Created By: Jovanna Badger On 02/06/2025 at 11:15 AM
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GOLDFELD, GALINA & GOLDFELD, VLADIMIR
FACILITY NUMBER: 384001243

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, it was found that the licensee did not consistenly document the 15-minute increment checks for infant safe sleep logs. This lack of consistent documentation poses a potental risk to the Health and Safety, or personal righs of infants in care.
POC Due Date: 02/20/2025
Plan of Correction
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**Ammended Report**
The Licensee must consistently document the 15 minute checks for all infants during nap time. These records must be available for review upon request. A follow up visit is required to verify that the center has implented the change. The plan of correction is due 2/20/2025.
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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Jovanna Badger
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025


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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GOLDFELD, GALINA & GOLDFELD, VLADIMIR
FACILITY NUMBER: 384001243
VISIT DATE: 02/06/2025
NARRATIVE
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PGE 2..

LPAs reviewed five children's' records. LPA also reviewed facility records. Both Licensees and Aide's have CPR & First Aid Certificates that are valid. Licensee's and Aide's Mandated Reporter Training are up to date. The last Emergency drill was conducted 01/10//2025. Emergency drills are be conducted monthly and are properly logged.

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 the 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.

Per Licensees, there are no children enrolled with allergies. Incidental Medical Services (IMS) policy was discussed. For IMS information 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: on 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 www.ada.gov/childqanda.htm.

LPAs encouraged the Licensees to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensees can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

LPAs discussed the safe sleep regulations with Licensees 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.

Continued on Page 3...

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Jovanna Badger
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GOLDFELD, GALINA & GOLDFELD, VLADIMIR
FACILITY NUMBER: 384001243
VISIT DATE: 02/06/2025
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LPAs also informed Licensees 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.

Licensees were informed of the MyChildCarePlan.org website; 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.



During the exit interview, the Licensees confirmed that there are no Registered Sex Offenders living in the facility and LPA Van completed the RSO profile.

A copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.

Exit interview conducted and report was reviewed with the Licensees, Galina and Vladimir Goldfeld.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Jovanna Badger
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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