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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004960
Report Date: 12/06/2022
Date Signed: 12/06/2022 10:56:49 AM

Document Has Been Signed on 12/06/2022 10:56 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:BASNINA, ANASTASIIAFACILITY NUMBER:
414004960
ADMINISTRATOR:BASNINA, ANASTASIIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 699-3337
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/06/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Anastasiia BasninaTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Andrea Medlin met with applicant for this prelicensing visit due. Days and hours of operation: Monday-Friday 8:00AM-5:30PM. Applicant states that she, husband, and one minor child reside in the home. Applicant rents the home; control of property documents verified and are on file. The entire home is inspected for health and safety hazards. This is a one level home. There are four bedrooms, 2 bathrooms, kitchen, dining area, living room, backyard. The daycare will operate in the following areas: living room converted into daycare room, bathroom, dining area adjancent to kitchen, and use the three bedrooms for either napping or classroom space. The off limits areas will be: kitchen and master bedroom/bathroom.The backyard will be used for outside time. There is a play structure cushioned with tanbark underneath. There is a fully charged fire extinguisher that meets minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the home. First Aid and emergency supplies are available. Applicant will separate a sick child from the group waiting for parent to pick up. Per applicant, there are no firearms or weapons in the home. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Applicant has current Pediatric First Aid and CPR and 8 hours of Health and Safety training is on file. There are sufficient age appropriate toys and children's equipment in the day care. Bathroom is clean and hazardous material is child proofed and inaccessible to children. Per applicant, she plans to purchase liability insurance for the daycare. If liability insurance is not purchased, parent's must be given the licensing form "Affidavit of liability insurance"(LIC 282) form. Applicant has verification of the required staff immunizations. Applicant advised to conduct emergency disaster drills at least once every six months and log the date and time of the drill.

If child care is provided to the 7tth and 8th child, children must be school age (6 years or older), Parent Notification, and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).

Pending criminal record clearance for applicant's spouse, then licensure will be recommended and approved. This report is reviewed with applicant and a copy of this report must be made available for pubic review upon request.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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