414004840-8-3-2023-05-CC-LGOZ-CUD226-20230803170009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004840
Report Date: 08/03/2023
Date Signed: 08/03/2023 05:00:19 PM

Document Has Been Signed on 08/03/2023 05:00 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:	OSTROVSKA, OKSANA		FACILITY NUMBER:	414004840
ADMINISTRATOR:	OSTROVSKA,O		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 967-6856
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94065
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	08/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Oksana Ostrovska		TIME COMPLETED:	05:05 PM

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 8/3/2023 at 1:55PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Oksana Ostrovska. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility was the licensee and two assistants caring for 11 children. Children present are preschool age. Licensee’s home is a four bedroom, two bathroom, one level house. Days and hours of operation are: Monday- Friday, 8:00AM. to 6:00PM. Day-care Area: Kitchen, Dining Room, Bathroom #1 Bedrooms # 3 (Activity Room), Bedroom #4 (Napping Only), and Backyard. Off-limit Area: Bedroom #1, #2, Bathroom #2, Front Yard, and Garage. LPA inspected facility, indoor and outdoors, with licensee for health and safety hazards. At 2:00PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors/ground was clear of obstructions or hazards. Accessible furniture, blocks, and books were in good repair. Labeled cubbies are located in entry way for storage of children’s belongings. Child sized table and chairs are available for seated activities. Cabinets, drawers in kitchen area have safety locks installed. For napping services, LPA observed napping beds in bedroom #4. Per licensee, napping supplies are washed weekly. The off-limit areas have been made inaccessible with child safety gates. Bathroom #1 was maintained clean with adequate supplies for hand washing. Fixtures tested were in operating condition. Facility was the proper temperature, with adequate ventilation and lighting. Home had functioning telephone service, smoke/ carbon monoxide detector, and fire extinguisher: 3A:40:BC. Pull handle, fire alarm is located near entry way. At 2:25PM., LPA inspected the outdoor play area. Area was completely enclosed, with playthings and climbing structure in good repair. Structure had been properly anchored. Backyard was free of any hazardous plants. Home does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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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Document Has Been Signed on 08/03/2023 05:00 PM - It Cannot Be Edited

Created By: Luis Gomez On 08/03/2023 at 03:43 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: OSTROVSKA, OKSANA	FACILITY NUMBER: 414004840
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 3:15PM., Based on record review, LPA confirmed immunization record missing from day-care child's file. This poses a potential health and safety risk to children in care.
	POC Due Date: 08/07/2023
	Plan of Correction
1 2 3 4	Licensee will ensure day-care child, C11, file is populated required licensing forms and immunization record by the due date: 8/7/2023. Proof of correction will be submitted to the department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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: OSTROVSKA, OKSANA	FACILITY NUMBER: 414004840
	VISIT DATE: 08/03/2023

NARRATIVE

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At 2:35PM, LPA reviewed facility records including the children and personnel files.

Personnel files were reviewed and included the: (LIC508) Criminal Record Statement and (9052) Notice of Employee Rights.

LPA reminded licensee to ensure staff complete the required 'Mandated Reporter Training' (AB1207). Advisory Note, Technical Violation (LIC9102TV) was issued.

At 3:00PM., Based on record review, LPA confirmed staff, S1, missing required immunization in facility file. Advisory Note: Technical Violation (LIC9102TV) was issued.

Children’s files were reviewed and included the: Notification of Parent's Rights (LIC995); Identification of Emergency Information (LIC702); and Consent for Medical Treatment (LIC627).

At 3:15PM., Based on record review, LPA confirmed immunization record missing from day-care child's file.

Children’s Roster (LIC9040) had been updated.
Licensee's Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 7/2025.
Licensee’s ‘Mandated Reporter Training Certification’ (AB1207) was current, expiring: 8/25/2023

Licensee to conducting emergency disaster drills every 6 months, with last drill completed on 4/25/2023, properly logged.

Required posting are posted in facility, including the Childcare License and Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC612A). Per licensee, isolation of an ill children is in the bedroom #3.

Per licensee, she provides food services for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled. Per licensee, home does not have any firearms.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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: OSTROVSKA, OKSANA	FACILITY NUMBER: 414004840
	VISIT DATE: 08/03/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: 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 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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were cited in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations and cited on 809D. LPA conducted exit interview, and discussed evaluation report and plan of correction licensee, Oksana Ostrovska. Licensee’s signature of this form acknowledges receipt of these documents.

During exit interview, licensee, Oksana Ostrovska confirmed that there are no registered sex offenders living in the facility. Notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC809 (FAS) - (06/04)

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