414004960-3-17-2025-05-CC-LGOZ-DEUVUV-20250317164523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004960
Report Date: 03/17/2025
Date Signed: 03/17/2025 04:45:35 PM

Document Has Been Signed on 03/17/2025 04:45 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:	BASNINA, ANASTASIIA		FACILITY NUMBER:	414004960
ADMINISTRATOR/ DIRECTOR:	BASNINA, ANASTASIIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 699-3337
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	03/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:10 PM
MET WITH:	Olga Basnina, Anastasiia Basnina		TIME VISIT/ INSPECTION COMPLETED:	04:55 PM

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On 3/17/2025 at 2:10PM., Licensing Program Analyst (LPA), Luis Gomez met with Assistant, Olga Basnina. The purpose of today’s visit was explained and was for an unannounced, annual/ random inspection. Licensee, Anastasiia Basnina arrived during inspection. Present was the licensee and two assistants caring for 11 children. (7 preschool-age and 4 infant-age) Adults have criminal record clearances on file. Licensee’s home is a four bedroom, two bathroom, one level house. Days and hours of operations are: Monday- Friday, 8:00AM- 5:30PM. The areas of the home designated for childcare are: Living Room (Playroom); Dining Area; Bedroom #2 (Napping Only); Bedroom #3 (Napping Only); Bedroom #4 (Activity Room); Bathroom #1 and Backyard Area. Areas of the home designated as off-limits: Bedroom #1; Bathroom #2; and Garage. LPA inspected facility indoors and outdoors for health and safety hazards.

At 2:15PM., the following was observed: Facility was clean, neat, with age-appropriate playthings available for the children. The floors and ground surfaces were clear of any obstructions or hazards. LPA observed hangers available for storage of children’s belongings. For food services, LPA observed table, chairs, scaled to the appropriate size. Children’s furniture and toys inspected were in good repair, and free of sharp corners or splinters. Fireplace in playrooms has been barricaded.

At 2:20PM., LPA observed infant swing in facility playroom. Advisory Note: Technical Violation (LIC9102TV) was issued.

For napping services, cribs and mats stored in bedroom #2. Cribs inspected were equipped with tight-fitting sheet and properly sized mattress. Per Licensee, napping supplies and sheets are washed by families weekly.

Bathroom #1 was observed clean, with faucet and toilet in operating condition. Detergents, cleaning compounds, and item which can pose a danger, have been stored in the off-limit areas. Facility was a comfortable temperature, ventilation, and lighting. Facility has telephone service; carbon monoxide/ smoke combination detectors; and fire extinguisher (3A:40BC). (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

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: BASNINA, ANASTASIIA	FACILITY NUMBER: 414004960
	VISIT DATE: 03/17/2025

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(PAGE 2)
At 2:40PM., LPA inspected the backyard area. Area was completed fenced with plaything in good repair. Climbing structure was properly anchored, with absorbent material (tanbark) installed below and around climbing structure. LPA reminded licensee to ensure tanbark is spread out evenly.
Facility does not have any pools; fishpond; jacuzzi; or other bodies of water.

At 2:55PM., LPA reviewed facility records including children and staff files.
The staff file was reviewed and included the Proof of Immunization; Acknowledgment to Report Suspected Child Abuse (LIC9108); and Notice of Employee Rights (LIC9052).

The children’s files were reviewed and included the: Identification and Emergency Information (LIC700); and Notification of Parents Rights (LIC995).

Licensee is documenting infant napping conditions during each 15-minute review.

At 3:30PM., Based on record review, LPA confirmed several children's immunization records missing from facility files. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee’s cardiopulmonary resuscitation (CPR)/ Pediatric First Aid Certification was current, expiring: 10/19/2026.
Licensee’s proof of completed mandated reporter training course (AB1207) was current, expiring: 9/2026.

Facility is conducting emergency disaster drills every six months, with last drill completed on 3/3/2025.

The required forms are posted in entry and include the: License; Notification of Parent’s Rights (PUB379); and Written Emergency Disaster Plan (LIC610).

Per licensee, isolation of an ill child is in the playroom. Per licensee, facility provides daily snack/ meal service. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

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: BASNINA, ANASTASIIA	FACILITY NUMBER: 414004960
	VISIT DATE: 03/17/2025

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(PAGE 3)
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.

LPA discussed safe sleep regulations with licensee and the 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.

Facility 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.(REFER TO 809C., FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

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: BASNINA, ANASTASIIA	FACILITY NUMBER: 414004960
	VISIT DATE: 03/17/2025

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(PAGE 4)
Based on today's inspection, no deficiencies were cited in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety Code of Regulations. An exit interview and facility evaluation report was discussed with Licensee, Anastasiia Basnina.
Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee confirmed no registered sex offenders are living in the facility, and LPA completed RSO profile. 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: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

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