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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004061
Report Date: 11/27/2023
Date Signed: 11/27/2023 12:09:10 PM

Document Has Been Signed on 11/27/2023 12:09 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:KHILKO, NATALIAFACILITY NUMBER:
414004061
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Natalia KhilkoTIME COMPLETED:
12:30 PM
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On November 27, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an announced capacity increase inspection in conjunction with required annual inspection. LPA met with licensee, Natalia Khilko, and explained the purpose of the inspection. Present during inspection was licensee.

Licensee submitted an increase of capacity application to Regional Office on October 30, 2023. Licensee has been a licensed daycare provider since 11/18/2015. Hours of operation are Monday to Friday from 8:00am to 6:00pm.

LPA and Licensee toured home for health and safety hazards. Licensee is adding bedroom #2 and kitchen/dining room to daycare areas. The DAY CARE AREAS are the living room (playroom), kitchen/dining room, bathroom, Bedroom #1 and #2, outdoor deck, and backyard. The OFF-LIMIT AREAS are bedroom #3 and garage. Licensee was notified any off-limit areas are not to be used as a day care area without prior approval from department.

LPA observed home to be equipped with a variety of age-appropriate toys, learning materials, and sleeping mats that are in good condition. Outdoor area is equipped with deck and grass area. Side of home is made inaccessible by locked gates. Deck area is equipped with sand table, child size table and rope swing hanging from tree. Per Licensee, other outdoor toys are available for children. LPA did not observe any pools, spas, or bodies of water on the property. All cleaning supplies, poisons, other chemicals, and sharp objects were stored inaccessible to children on high shelves and/or behind child safety locked cabinets. Per licensee, there are no weapons or firearms in the home.

Home is equipped with a fully charged fire extinguisher, smoke/carbon monoxide detectors and fully stocked first aid kit. The licensee's CPR and First Aid training is current and will expire 10/2025. The licensee's Mandated reporter training is also current and will expire 11/2025. Licensee was reminded baby walkers, bouncer, jumpers, and any other similar items are not to be used for children in care.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2023
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KHILKO, NATALIA
FACILITY NUMBER: 414004061
VISIT DATE: 11/27/2023
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Capacity limits and ratios for a large family day care have been reviewed with licensee on this date. LPA reminded licensee that an assistant must be present when operating as a large license. LPA reminded licensee when an assistant is not present, licensee must operate as a small license.

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.

During today's visit, no deficiencies were cited.

Prior to approval of large license, the following must be completed:

-Fire inspection Clearance.

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

Exit interview conducted and report was reviewed with licensee, Natalia Khilko.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC809 (FAS) - (06/04)
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