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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004766
Report Date: 02/03/2022
Date Signed: 02/03/2022 12:14:25 PM

Document Has Been Signed on 02/03/2022 12:14 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:BAKIROVA, HANNA & BAKIROV, MYKHAILOFACILITY NUMBER:
414004766
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
02/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Licensees, Hanna & MykhailoTIME COMPLETED:
12:20 PM
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On February 3rd, 2022 at 10:40am, Licensing Program Analyst (LPA) Kassandra Medrano met with Licensees, Hanna and Mykhailo, the purpose of the visit was explained. LPA conducted an annual random inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee today. Present in the home is the two licensees and 5 children. Capacity and ratio requirements of children was observed in compliance today. This type of home is a two story. Off limit rooms were identified as, the entire upper level, the garage, and the kitchen. Adults living in the home are the Licensees. Licensees rent home. The day-care operates Monday through Friday 8 am-6 pm. Licensee does not have day-care insurance, and has parents sign the affidavit. LPA observed the following: Stairs in the home are properly barricaded at top/bottom if caring for children under five years old. Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensees state there are no bodies of water on the premises. There is a fireplace in the day-care area, and is properly barricaded. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee states there is a pet in the home: one cat. Vaccinations are current. Licensees CPR and First Aid expires: 1/2023. Emergency drills are conducted at least once every six months and properly logged. Licensee does provide daily snacks and lunch. Some of the families opt out and bring their own food from home. Food is labeled. Isolation of sick children reviewed/discussed.Children’s roster was reviewed and is complete and up-to-date. Children files were reviewed and are complete. Supervision and transportation of children was discussed. Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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: BAKIROVA, HANNA & BAKIROV, MYKHAILO
FACILITY NUMBER: 414004766
VISIT DATE: 02/03/2022
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Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist)

Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Licensee was informed about the Provider Information Notices (PINs) on CCLD website. Licensee was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com). Information regarding 'A Child Care Provider's Guide to Safe Sleep' was provided to the Licensee and is available for review on CCLD website.


This report and appeal rights were discussed with Licensee. This report must be available in the facility for public review. Notice of Site Visit was posted. Notice to remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
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