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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001337
Report Date: 05/02/2025
Date Signed: 05/02/2025 11:41:25 AM

Document Has Been Signed on 05/02/2025 11:41 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: 6CENSUS: 5DATE:
05/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Nino Osepashvili and Liliana GoldenshteynTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On May 2, 2025, Licensing Program Analyst (LPA) Van conducted an announced annual inspection and met with the Licensee’s assistant, Nino Osepashvili. The purpose of the inspection was explained, and the licensee’s assistant granted LPA access to the home. Upon entering the house, LPA observed the children having story time with another assistant. The licensee, Liliana Goldenshteyn, and her adult daughter came down from the upper floor a moment later. The licensee and two assistants supervised five children (two infants and three preschoolers). The licensee complies with her licensed capacity and limitations.

The licensee, staff, and individuals residing in the home have had their criminal record clearances verified through the CDSS Background Check System, and they are confirmed to have eligible clearance status on file.

According to the Licensee, the previously approved childcare areas were not changed. 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 operation are Monday through Friday from 8:00 a.m. to 5:30 p.m.
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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 05/02/2025
NARRATIVE
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LPA toured and inspected the childcare spaces to identify any possible health and safety risks. The childcare areas were tidy and well-structured, featuring age-appropriate books and activities that promote learning and exploration for the children. The home provides sufficient heating, lighting, and ventilation. It has a carbon monoxide detector, a smoke detector, and a fully charged fire extinguisher that complies with the minimum standard of 2A 10 BC. No fireplace was observed in the approved childcare areas.

Cleaning products and disinfectants were observed to be kept out of the reach of children. The licensee confirmed that there are no firearms or weapons in the residence. No baby walkers, bouncers, or similar equipment were observed in the childcare spaces. The licensee was reminded that smoking is prohibited within the family childcare home.

Four cribs were observed. Two out of three crib bedsheets were loose and appeared dislodged. LPA reviewed the infant’s safe sleep regulation with the licensee and reminded her to ensure that all bedsheets are tightly fitted to prevent dislodgement, as this could pose choking or suffocation risks. During the inspection, the licensee installed two new sheets, which were tightly fitted.

The infant sleeping logs were provided to LPA for review. Upon checking, it was found that the logs were complete, including the child's name, birthdate, and the 15-minute increments. LPA also reminded the licensee to maintain a minimum of 30 days of logs for review during the annual inspection, and the records must be kept for 3 years.

Temporary absence was discussed, and the licensee's questions or inquiries were answered.
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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GOLDENSHTEYN, LILIANA R.
FACILITY NUMBER: 384001337
VISIT DATE: 05/02/2025
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During the visit, LPA reviewed the records for both children and personnel. The licensee keeps an accurate record of the child, including vaccination records, parental rights forms, and complete emergency information. The licensee and all assistants have valid Pediatric First Aid CPR and valid mandated reporter training certificates. LPA reminded the licensee that all required immunizations must be available for review during the inspection, as one of the assistants and the licensee did not have Tdap on file. A technical violation was issued. Additionally, LPA also informed the licensee that if the staff members don’t take the influenza shot, they must ensure that the flu declination is on file.

All the required licensing postings were observed posted. According to the licensee, regular fire and earthquake drills are conducted at least once every six months, with the most recent drills completed on 1/6/2025.

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.
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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 05/02/2025
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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.

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.

During the exit interview, the LICENSEE, LILIANA GOLDENSHTEYN, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

During the inspection, LPA reviewed the technical violation with the licensee. The licensee states that they will send LPA the missing immunization.

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, Liliana Goldenshteyn.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
LIC809 (FAS) - (06/04)
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