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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001337
Report Date: 04/22/2024
Date Signed: 04/22/2024 11:19:51 AM

Document Has Been Signed on 04/22/2024 11:19 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GOLDENSHTEYN, LILIANA R.FACILITY NUMBER:
384001337
ADMINISTRATOR/
DIRECTOR:		GOLDENSHTEYN, LILIANA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 681-1571
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
04/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Nino OsepashviliTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On April 22, 2024., Licensing Program Analysts (LPAs) Van and Alvarado conducted a required inspection and met the Licensee’s helper, Nino Osepashvili. Per Ms. Osepashvili, the Licensee, Liliana Goldenshteyn, has a doctor's appointment. LPAs explained the purpose of the inspection to the Licensee helper and were given access to the home. LPAs observed two helpers supervising four children upon entering the house (three infants and a preschooler). The facility complies with the licensing capacity and limits today. All adults present during the inspection have cleared criminal clearance verified with the CDSS Guardian site. Another helper/licensee’s daughter, Ruzana Mamysheva, and a child arrived during the inspection.

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 floor only, including the playroom, kitchenette, nap room, bathroom, and backyard. The off-limit areas are the garage and the entire second-floor level. All off-limit areas are appropriately barricaded. The days and hours of the operation are Monday – Friday from 8:00 am – 5:30 pm.

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. No fireplace was observed in the childcare areas. 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2024
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 04/22/2024 11:19 AM - It Cannot Be Edited


Created By: Brendon Van On 04/22/2024 at 10:41 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GOLDENSHTEYN, LILIANA R.
FACILITY NUMBER: 384001337

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2024

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, the licensee did not comply with the section cited above. She did not document the infant's sleep logs properly and consistently. The licensee did not indicate the dates the check was made, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 05/06/2024
Plan of Correction
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Licensee must ensure that the 15-minute check must be documented with an initial. The facility representative agrees, moving forward, to document the sleep checks for all infants under 24 months old and email them to LPA by the stated date.
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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2024


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: GOLDENSHTEYN, LILIANA R.
FACILITY NUMBER: 384001337
VISIT DATE: 04/22/2024
NARRATIVE
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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 artificial turf was installed on the backyard floor to prevent accidental falls.

During the inspection, LPAs observed that the facility had three cribs and a playpen. LPAs reminded the facility representative 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 helpers present have maintained complete records and have met all the necessary licensing requirements, including completing required immunizations, mandated reporter training, and maintaining 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 facility representative, regular fire and earthquake drills are conducted at least once every six months. The latest drills were completed on 1/8/2024.

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

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
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: GOLDENSHTEYN, LILIANA R.
FACILITY NUMBER: 384001337
VISIT DATE: 04/22/2024
NARRATIVE
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During the inspection, LPAs reviewed forms/records to keep in your family's child care homes, children's forms/records, and personnel forms/documents with the Licensee. In addition, license capacity and limitations were also reviewed with the licensee.

The facility representative 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.

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

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
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: GOLDENSHTEYN, LILIANA R.
FACILITY NUMBER: 384001337
VISIT DATE: 04/22/2024
NARRATIVE
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Facility representative 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.

Facility representative 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 deficiency cited today.

During the exit interview, the LICENSEE REPRESENTATIVE, NINO OSEPASHVILI, 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 facility representative, Nino Osepashvili.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC809 (FAS) - (06/04)
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