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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004743
Report Date: 11/30/2021
Date Signed: 11/30/2021 11:11:39 AM

Document Has Been Signed on 11/30/2021 11:11 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LOZINSCAIA, TATIANAFACILITY NUMBER:
414004743
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
11/30/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee, Tatiana Lozinscaia and A1TIME COMPLETED:
11:30 AM
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On November 30, 2021 at 9:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an announced, case management- increase of capacity inspection. LPA met with licensee, Tatiana Lozinscaia, and explained purpose of the inspection. Licensee speaks Russian and contacted licensee's adult child (A1) for translation.

Present in the home were licensee, A1 (translation only) and 4 enrolled children (4 infants). Licensee is operating within capacity requirements on this day. The licensee currently rents the home. Proof of control of property was reviewed. All adults working in the facility have criminal record clearance on file. Hours of operation are Monday to Friday from 8:00am to 6:00pm. The licensee is currently licensed for a Small Family Child Care Home and applied for a Large Family Child Care Home license November 17, 2021. The licensee obtained a fire clearance and was approved November 22, 2021.

At approximately 9:30am, LPA and A1 inspected entire home for health and safety hazards. The home is a multi-level, single family home that consists of four bedrooms, two bathrooms, living room, dining area, kitchen, backyard and garage. The DAY CARE AREAS are bedroom #1 (classroom), bedroom #2 (activity room), bedroom #3 (nap room), and bathroom #2, kitchen, dining area and front portion of backyard. The OFF-LIMIT AREAS are bedroom#4, (located on lower level of home), bathroom #1 (located in nap room), garage and back portion of backyard. All off limit areas are properly barricaded with child safety gates and/or locked doors.

LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of age appropriate toys that were in good condition. Outdoor area is equipped with age appropriate toys and materials that were also in good working condition. There were no 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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LOZINSCAIA, TATIANA
FACILITY NUMBER: 414004743
VISIT DATE: 11/30/2021
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LPA observed a fully charged fire extinguisher, multiple smoke/carbon monoxide detectors, and working telephone on site. Per licensee, there are no weapons or pets in the home. Garbage cans have tight fitting lids. The home does contain a fireplace that is properly barricaded with resilient padding. Licensee and A1 were reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care.

Licensee provides food service with breakfast, lunch and afternoon snacks. Food storage, sanitization, and children’s allergies were discussed. Licensee provides sleeping cots, mats, sheets and blankets. Safe sleep regulations, laundering, COVID-19 guidelines and sanitization was discussed. The licensee's CPR and First Aid training is currently and will expire October 2023. Licensee was reminded CPR , First Aid and Mandated Reporter training must be renewed every two years.

Capacity limits and ratios for a Large Family Day Care have been reviewed with licensee. LPA reminded licensee that assistant must be present.

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: http://www.ada.gov/childqanda.htm

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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LOZINSCAIA, TATIANA
FACILITY NUMBER: 414004743
VISIT DATE: 11/30/2021
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Prior to approval of Family Child Care Home Large License, the licensee must complete the following:
-Installation of child safety lock on kitchen drawer.
-Installation of child safety lock on laundry door.
-Installation of heater vent cover located on kitchen floor.

Licensee was advised to contact San Bruno Regional Office for concerns or questions. Desk Duty is available M-F, 8:00am to 5:00pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing

This report is public and can be reviewed. A copy of this report will be emailed to licensee. Licensee was advised to acknowledge receipt of report once received.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
LIC809 (FAS) - (06/04)
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