384004696-5-6-2026-05-CC-CQUO-DTTP67-20260506110153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004696
Report Date: 05/06/2026
Date Signed: 05/06/2026 11:02:09 AM

Document Has Been Signed on 05/06/2026 11:02 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	LEVINA, VIOLETTA & NIKOLSKAIA, IANA		FACILITY NUMBER:	384004696
ADMINISTRATOR/ DIRECTOR:	LEVINA, VIOLETTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 409-9017
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 10	DATE:	05/06/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:25 AM
MET WITH:	Violetta Levina & Iana Nikolskaia		TIME VISIT/ INSPECTION COMPLETED:	11:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 6, 2026 at approximately 8:25am, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, annual inspection. LPA met with co-licensee (CL1), Violetta Levina, and explained the purpose of the visit. Upon LPA's arrival, children were arriving to the facility. Co-licensee 2 (CL2), Iana Nikolskaia, was not present at start of LPA's visit. Per CL1, CL2 is at the bank and will be returning. Main entrance to the day care area is through the side door with a doorbell. Hours of operation are Monday through Friday 8:00am to 5:30pm. CL1 lives in the multi-level home with CL1's spouse, CL2, and CL2's minor child. Adults living in the home have fingerprint clearance on file and are associated to facility's license number. At approximately 9:00am, 10 children (4 infants and 6 preschool age children) were present with CL1 and assistant. LPA observed assistant present to have fingerprint clearance and association to facility's license number. Home is a large license and has an assistant present, therefore facility is operating within capacity limits and ratio. With CL1, LPA inspected day care areas for health and safety hazards. The DAY CARE AREAS are located on the ground level of the home only that includes the playroom (main day care area), hallway by side entrance, toilet and sink bathroom #1 (located in playroom) and backyard. The OFF LIMIT AREAS are the bathtub and standing shower in bathroom #1, piano room on the ground level of the home, garage and entire second level of the home. LPA observed off limit areas are made inaccessible with a child safety door handle or a child safety gate. There are stairs in the home that lead to the second level of the home that are also made inaccessible with a child safety gate. (Continue report on page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LEVINA, VIOLETTA & NIKOLSKAIA, IANA	FACILITY NUMBER: 384004696
	VISIT DATE: 05/06/2026

NARRATIVE

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Main day care area includes children's toys, materials and furniture that are age appropriate and in good condition. Playroom includes area for blocks, kitchen play, soft play, and arts and crafts. Per CL1, children's materials are sanitized daily and deep cleaned once a month. There is a rug in the playroom that was observed to be clean, free of stains. Per CL1, rug is vacuumed twice a day while floor is also washed twice a day. LPA did not observe accessible, electrical outlets in playroom. There is a fireplace that is barricaded and made inaccessible. LPA also observed fireplace corners to be padded for additional safety. Cabinets for children's materials also include padded corners.

Hallway for children's use includes children's chairs and areas for children's personal belongings. LPA observed areas for children's personal belongings to be labeled with children's individual names.

At approximately 9:20am, CL2 arrived to facility. LPA continued visit with both co-licensees. Licensing documents are posted in the main hallway of facility, available for review. LPA observed all required licensing documents to be posted.

Bathroom for children's use was observed to be in working condition. Bathroom is equipped with age appropriate toileting equipment. LPA also observed children's potty training chairs to be labeled with their individual names. There is a diaper changing table in the home that stored in closet, when not in use. Per CL1, children's families provide diapers and wipes for children. LPA observed children's diapers to be labeled with their individual names. Home is equipped with a garbage bin with a tight fitting lid to dispose of dirty diapers.

Backyard is fully enclosed and fenced. LPA observed outdoor area to include a variety of outdoor equipment that are in good condition. Flooring in backyard also includes artificial turf that was in good condition. Per CL1, artificial turf was recently replaced. LPA did not observe any pools, spas or bodies of water on site.

Children sleep in the main day care area. Preschool children sleep on cots while infants sleep in cribs. Per CL1, sheets and blankets for preschool children are provided by children's families and are sent home every two weeks for laundering. LPA observed children's sheets and blankets to be stored appropriately, without touching each other. Per CL1, infants sleep in a crib that is free of loose articles and objects. LPA also observed cribs to be free of loose articles and objects.

LPA reviewed sleeping logs for infants. Sleeping logs include the 15 minute time stamp of when the infant is checked on while sleeping and the initials of the individual checking on the infant. LPA reviewed random sleeping logs from April 2025, June 2025, November 2025, and February 2026, which are maintained. LPA also observed children's records to include completed Individual Infant Sleeping Plan forms (LIC9227) for infants.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

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: LEVINA, VIOLETTA & NIKOLSKAIA, IANA	FACILITY NUMBER: 384004696
	VISIT DATE: 05/06/2026

NARRATIVE

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LPA discussed the safe sleep regulations with co-licensees and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing any 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.

Children eat in the main day care area. Co-licensees provide a food service that includes breakfast, lunch and snack. Food is prepared in off limit kitchen on second floor and brought to the main day care area. Both reusable and disposable utensils and plates are utilized for children. LPA observed home is equipped with a dishwasher to sanitize reusable utensils and plates daily. Per CL1, no children currently enrolled have any allergies.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/

Home is equipped with a fully charged fire extinguisher, first aid kit and combination of a smoke and carbon monoxide detector. LPA tested detector during today's visit which was observed to be in working condition. Emergency disaster drills are conducted and documented. Last documented drill was conducted April 30, 2026. Per CL1, there are no weapons or firearms in the home. Per CL1, no overnight care is provided nor are there any pets in the home.

LPA reviewed facility's records. A childcare roster is maintained and was made available for review. LPA also reviewed enrolled children's and staffing records, which were all complete. Children's records are complete with emergency information and immunization records. Staff records (CL1, CL2 and assistant present) are complete with current Pediatric CPR and First Aid certifications, current Mandated Reporter certifications and proof of required immunizations. Liability insurance is maintained and was made available for LPA's review.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

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: LEVINA, VIOLETTA & NIKOLSKAIA, IANA	FACILITY NUMBER: 384004696
	VISIT DATE: 05/06/2026

NARRATIVE

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Co-licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Co-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 co-licensee, Violetta Levina, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

No deficiencies were issued during today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the co-licensee, Violetta Levina and Iana Nikolskaia.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

LIC809 (FAS) - (06/04)

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