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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004743
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:22:48 PM

Document Has Been Signed on 06/11/2024 03:22 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:LOZINSCAIA, TATIANAFACILITY NUMBER:
414004743
ADMINISTRATOR/
DIRECTOR:		LOZINSCAIA, TATIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 686-9700
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Tatiana LozinscaiaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On June 11, 2024 at approximately 1:00 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with licensee,Tatiana Lozinscaia and adult daughter, and explained the purpose of the inspection. Present in the home were licensee, a helper (H1), licensee's adult child (A1), and 8 enrolled children (2 infants and 6 preschool age). A1 arrived to the facility at approximately 1:30 PM. A1 does not live or work in the home and is present during LPA's visit for translation only. 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 and A1 speak Russian. Visit was translated in Russian by A1.

Hours of operation are Monday to Friday from 8:00am to 6:00pm. Licensee lives in a multi-level home. The home 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. LPA observed all required licensing documents to be properly posted and available for review near front door.

Day Care Areas: 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.
Off Limit Areas: lower level of home, upper portion of backyard, bathroom #2 in napping room, and garage. Off-limit areas are barricaded with child safety gates and/or child safety door handles.
At approximately 1:50 PM, LPA toured day care areas of home with licensee and A1. LPA observed the home to be in repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPA observed a fully stocked accessible first aid kit located in the hallway closet near the dining room. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPA observed electrical outlets to be made inaccessible with built in outlet covers. Home is equipped with a fully charged fire extinguisher and multiple dual smoke and carbon monoxide detectors. LPA did not test carbon monoxide detector in main Day Care area due to children in care sleeping. Safety locks are installed in cabinets of the kitchen area. Licensee does not have any children in care with allergies or IMS plans. Per licensee, she provides all food for the children in care.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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: LOZINSCAIA, TATIANA
FACILITY NUMBER: 414004743
VISIT DATE: 06/11/2024
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LPA observed bathroom for children's use was in proper working condition. LPA observed bathroom to include appropriate toileting equipment and sanitation products. LPA did not observe any hazardous materials to be accessible to children in the bathroom.
The entire backyard is fully enclosed. The outdoor area is equipped with a variety of toys, materials, and a built in play structure. Stairs in back yard area were made inaccessible with a child safety gate.
LPA did not observe any pools, spas, or bodies of water.

LPA reviewed five children records which were complete. The children’s files have a record of emergency identification information and required immunization. LPA reviewed staff records for licensee and H1 which were incomplete. Licensee's CPR/FIrst Aid is current and will expire 10/2024. The licensee’s Mandated Reporter training certification is not current and expired 10/06/2023. H1 has no Mandated Reporter and immunization record on file. The licensee was reminded that it is required for immunization to be on file, available for review. Two Type B deficiencies are being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

Licensee has licensing documentation properly posted and available for review. The licensee also maintains a childcare roster that was made available for review. Emergency disaster drills are not being conducted at least once every six months. Licensee was reminded to conduct and document emergency drills. Per licensee, there are no weapons or firearms in the home.

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.
Licensee was 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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: LOZINSCAIA, TATIANA
FACILITY NUMBER: 414004743
VISIT DATE: 06/11/2024
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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-andresources/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.

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/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Tatiana Lozinscaia and A1, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Two Type B deficiencies are being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

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

Exit interview conducted and report was reviewed with the licensee, Tatiana Lozinscaia and A1.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/11/2024 03:22 PM - It Cannot Be Edited


Created By: Janet Gil On 06/11/2024 at 03:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LOZINSCAIA, TATIANA
FACILITY NUMBER: 414004743

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in not having current Mandated Reporter Certificates which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/25/2024
Plan of Correction
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Licensee plans to retake training and send certificates to LPA within next 10 buissness days.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in not having any immunization on file for staff and herself which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/25/2024
Plan of Correction
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Licensee plans to locate immunization records for herself and H1 then send it to the department and place in staff files.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Garfield Leung
LICENSING EVALUATOR NAME:Janet Gil
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


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