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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001337
Report Date: 01/05/2023
Date Signed: 01/05/2023 11:58:14 AM

Document Has Been Signed on 01/05/2023 11:58 AM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GOLDENSHTEYN, LILIANA R.FACILITY NUMBER:
384001337
ADMINISTRATOR:GOLDENSHTEYN, LILIANA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 681-1571
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nino OsepashviliTIME COMPLETED:
12:00 PM
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 On January 5, 2023., Licensing Program Analyst (LPA) Van performed an annual 1-year mandatory inspection, which included checking the interior and exterior of the facility and discussing the required childcare paperwork with the Licensee. The purpose of the inspection was explained, and Licensee's helper, Nino Osepashvili, granted LPA entry to the facility. Licensee was at home. However, due to sickness, she has isolated herself on the second floor in off-limit areas. The helper supervised four children. During the visit, additional two children arrived. (3 infants & 3 preschoolers in total.) LPA reminded the Licensee's helper that she must comply with the capacity requirements for a Small Family Child Care Home since she is by herself. All adult living or working in the house has a criminal record clearance. Hours of operation currently are Monday-Friday from 7:30 am to 6:00 pm. Daycare areas are on the ground floor only, including the playroom, kitchenette, nap room, bathroom, and backyard. The off-limit areas are the garage and the entire second-floor level.
LPA and the helper toured the childcare areas for health and safety hazards. The childcare area is clean and organized, with age-appropriate toys and equipment. The house has sufficient lighting and ventilation. A functional telephone, multiple working smokes and carbon monoxide detectors, and a fully charged 2A10BC fire extinguisher are all in the house. LPA observed several play yards and booster chairs at the facility. LPA reminded the helper that booster chairs are used only when children are eating/feeding. LPA did not observe any toys or pillows inside and no objects hanging above the cribs/playpens. Licensee helpers stated she understood that all mattresses should be designed for that specific crib, and bedsheets should be tight-fitted.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2023
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GOLDENSHTEYN, LILIANA R.
FACILITY NUMBER: 384001337
VISIT DATE: 01/05/2023
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 LPA informed the helper to physically check on the infant every 15 minutes during naptime. Documentation shall be maintained in the infant's file and be available to the Department for review. The Licensee helper understood that no baby walkers, bouncers, exersaucers, or other similar items are permissible to be used during daycare hours. LPA did not observe any bodies of water on the premises. Daycare children have no access to detergents, disinfectants, or cleaning chemicals. The Licensee's helper stated the Licensee does not have guns or weapons in the house.
The Licensee and helper have valid CPR & First Aid certification until Jan 2024 and Mandated Reporter Training completed on July 9, 2022. Emergency drills are held once every six months, with the latest drills conducted on July 3, 2022, and each drill is appropriately logged/documented by the Licensee. Children's files were reviewed. The Licensee maintains thorough records for all children in their care, including vaccination records and Parental Rights forms. LPA noted that each kid had a complete emergency card with the child's full name, phone number, and the location of a parent or authorized person who may be called in an emergency. There is no transportation provided. Capacity options were reviewed with the helper, who acknowledges that care cannot be provided over the capacity specified on the license. The requirements for reporting suspected child abuse, as well as reporting requirements for unusual incidents, were discussed. All mandatory postings are posted (License/Parent's Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist).
The Licensee helper 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GOLDENSHTEYN, LILIANA R.
FACILITY NUMBER: 384001337
VISIT DATE: 01/05/2023
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 LPA discussed the safe sleep regulations with the Licensee's helper and 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 helper 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 registering all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
The 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.
The helper 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.
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 today's inspection, no deficiencies were observed. Today's report and site visit notice were provided to the Licensee's helper. The licensee helper, Nino Osepashvili, read and signed the report. LPA informed the Licensee helper that a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023
LIC809 (FAS) - (06/04)
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