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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004736
Report Date: 09/21/2021
Date Signed: 09/21/2021 04:48:39 PM

Document Has Been Signed on 09/21/2021 04:48 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:OSOKINA, EKATERINAFACILITY NUMBER:
414004736
ADMINISTRATOR:OSOKINA, EKATERINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 425-2170
CITY:SO. SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Maryna Viaraksa, Gulnorahon AbduvalievaTIME COMPLETED:
04:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Andrea Medlin met with two helpers, and later Licensee's husband, for this required annual visit. Purpose of visit explained. There are 10 children present during the visit; 2 infants and 8 preschool aged. Days and hours of operation: Monday-Friday 7:30AM-6:00PM. Licensee, husband, and one minor child reside in the home; criminal record clearance is on file for all adults. Physical plant toured to inspect for health and safety hazards in the licensed areas. The daycare has a fully charged fire extinguisher that meets the minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the home. First aid supplies are available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare area is kept clean and orderly and has adequate heating and ventilation for safety and comfort. Outdoor play area used for daycare is completely fenced. Per staff, there are no pets and no firearms or weapons in the home.he home. No spas, swimming pools, hot tubs, fish ponds, or similar or bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. A sick child would be separated from the group and wait for parent to pick up. Licensee and children's files reviewed. In the children's files reviewed, all have Parent's Rights (LIC 995A) form, Identification and Emergency Information (LIC 700), and verification of current immunizations. Licensee and helpers all have the required staff immunizations: measels (MMR) and pertussis (Tdap); Licensee has current Pediatric First Aid and CPR certification. Staff helpers will be exempt from the mandated child abuse reporter training (AB1207) due to training not offered in their primary language at this time. All the required licensing forms are posted in a prominent accessible location in the home.

This report is reviewed with staff and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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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