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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004964
Report Date: 11/28/2023
Date Signed: 11/28/2023 10:06:24 AM

Document Has Been Signed on 11/28/2023 10:06 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SKOBA, SVITLANAFACILITY NUMBER:
414004964
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/28/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Svitlana SkobaTIME COMPLETED:
10:26 AM
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On November 28, 2023 @ approximately 8:30pm, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced capacity increase inspection and met with Licensee, Svitlana Skoba and explained the purpose of the inspection. Licensee submitted an increase of capacity application to regional office on November 7, 2023. Licensee currently operates a small family daycare and is requesting a licensee for a large family daycare. Small daycare license was issued on December 08, 2022. Fire inspection was conducted on November 22, 2023, Licensee provided LPA with fire inspection approval letter from San Mateo Consolidated Fire Dept. Present today was Licensee, helper and 2 children (1 infant and 1 preschool age). All adults working at facility have fingerprint clearance. Licensee is operating within capacity and ratio requirements on this day. Hours of operation are Monday– Friday, 8:00 am - 5:30pm. Helper Caroline Daher helped with translation, as Licensee speaks Russian.

LPA and Licensee toured the home for health and safety hazards. The Day Care Areas: Playroom, Dining room, Bedroom #2, Bedroom #3, bathroom #2 and backyard. The Off-Limits Areas: Kitchen, living room, master bedroom, master bathroom, and garage. Entry into Kitchen area is properly barricaded with a child proof gate and entrance from playroom into living room is barricaded with toy storage cubbies. Fireplaces is in off limits area and is properly barricaded. Home is properly ventilated and has proper lighting. Home is clean and organized and all cleaning items and potentially harmful items are inaccessible to children and properly stored. Home is equipped with age of appropriate toys, child furnishings, books, learning materials and sleep mats. Backyard is properly surrounded with a 5 ft. fence. Backyard is equipped with plenty of play equipment including a swing set, playhouse, and ride on toys. Swing set is on cement patio and cushioned with rubber mats. There is also a grass area outside for children to play on. LPA did not observe any spas, pools, or other bodies of waters. Per licensee, there are no weapons or firearms in the home.

Home is equipped with a fully charged fire extinguisher, smoke/carbon monoxide detectors and fully stocked first aid kit. LPA observed a fire alarm installed in the playroom. The licensee's CPR and First Aid training is current and will expire 10/2024. The licensee's Mandated reporter training is also current and will expire 09/2024. Licensee was reminded baby walkers, bouncer, jumpers, and any other similar items are not to be used for children in care.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SKOBA, SVITLANA
FACILITY NUMBER: 414004964
VISIT DATE: 11/28/2023
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Capacity limits and ratios for a large family day care have been reviewed with licensee on this date. LPA reminded licensee that an assistant must be present when operating as a large license. LPA reminded licensee when an assistant is not present, licensee must operate as a small license.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During today's visit, no deficiencies were cited.

Prior to increase of capacity licensure, licensee will need to complete one year as a small, licensed childcare, one year anniversary will be on 12/08/2023.

LPA will recommend and approve a Large Family Child Care Home License, effective December 9, 2023.

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

Exit interview conducted and report was reviewed with licensee, Svitlana Skoba. Translation was provided by Caroline Daher.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
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