<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004743
Report Date: 10/27/2022
Date Signed: 10/27/2022 10:21:45 AM

Document Has Been Signed on 10/27/2022 10:21 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:LOZINSCAIA, TATIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 686-9700
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Tatiana Lozinscaia and A1TIME COMPLETED:
10:30 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 October 27, 2022 at approximately 8:20am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Tatiana Lozinscaia, and explained the purpose of the inspection. Present in the home were licensee, licensee's two helpers (H1 and H2), and 8 enrolled children (3 infants and 5 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have fingerprint clearance on file.

Licensee, H1 and H2 primarily speak Russian. Licensee contacted licensee's adult child (A1) for translation.

Hours of operation are Monday to Friday from 8:00am to 6:00pm. Licensee lives in 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 all on the main level of the home.

At approximately 9:00am, A1 arrived to facility. A1 does not live or work in the home and is present during LPA's visit for translation only.

LPA observed all required licensing documents to be properly posted and available for review near front door. The DAY CARE AREAS are the living room, kitchen, dining area, bedroom #1 (classroom), bedroom #2 (activity area/napping room), bedroom #3 (napping room), bathroom #2 (located in hallway), and front portion of backyard. The OFF LIMIT AREAS are entire lower level of home, upper portion of backyard, bathroom #2 (located in napping room), and garage. All off limit areas are properly barricaded with child safety gates and/or child safety door handles.

Home was observed to be clean, in good repair with proper temperature and ventilation. Living room includes a fire place that is properly barricaded and made inaccessible to enrolled children in care. LPA observed fire place to also include protection from sharp edges. Home is equipped with appropriate toys and equipment that were observed to be new and/or in good working condition. LPA observed cleaning supplies, poisons and other chemicals to be stored inaccessible to children in home's high shelves.
(Continue Report on Page 2...)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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: 10/27/2022
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
26
27
28
29
30
31
32
(Continued, Page 2...)
LPA observed there to be multiple carbon monoxide and smoke detectors throughout the home. The home is equipped with a working carbon monoxide detector, fully charged fire extinguisher and a fire alarm system installed.

Lower portion of backyard area was observed to be clean and equipped with age appropriate materials. LPA did not observe outdoor area to have any pools, spas or bodies of water on site. The upper portion of backyard area is made inaccessible with a child safety gate.

Per licensee and A1, there are no weapons or firearms in the home. LPA reviewed eight children's records which were complete. Children's files have a record of emergency identification information on file. LPA reviewed licensee, H1 and H2's files. Licensee's Pediatric First Aid/CPR certificate is renewed and will expire 10/2024. Licensee's Mandated Reporter training certificate is also current and will expire 10/2023. Both H1 and H2 have current Mandated Reporter training certificates that will expire 10/2024. LPA reminded licensee and A1 all newly hired staff must have proof of required immunizations available for review.

Licensee maintains safe sleep logs for napping infants in care. Sleeping logs include and document the 15 minute time checks of when infant was last check on while sleeping, infants' sleeping position and infants' temperature.

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.
(Continue on Page 3...)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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: 10/27/2022
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
26
27
28
29
30
31
32
(Continued, Page 3...)
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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview conducted and report was reviewed with the licensee, Tatiana Lozinscaia and licensee's adult child, A1 (for translation only).
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3