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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005046
Report Date: 10/03/2024
Date Signed: 10/03/2024 03:00:44 PM

Document Has Been Signed on 10/03/2024 03:00 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:POBEREZHNA, ALINAFACILITY NUMBER:
414005046
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Licensee, Alina PoberezhnaTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On September 03, 2024, at approximately 1:30pm, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, case management visit. LPA met with the licensee Alina Poberezhna and explained the purpose of the visit. Present during LPA's visit included the licensee, 1 staff assistant, and 5 preschool children.

Licensees requested to increase capacity from a small family child care home to a large family child care home. Capacity increase application was submitted to department September 12, 2024. Fire clearance approval has been obtained as on Sep 20, 2024

Licensees live in the home with their spouse and two children. Licensee was reminded if children live in the home under 10 years old, they are counted towards overall capacity. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 8:00am to 6:00pm

The DAY CARE AREAS now approved are the living room, day care room (napping room), bathroom #1, playroom, and part of the backyard. The OFF LIMIT AREAS are the garage, kitchen, bedroom #1, bedroom #2, bedroom #3 bathroom #2, and the laundry room. Off limit areas are made inaccessible with child safety door handles and/or a child safety gate. Home is equipped with a fully charged fire extinguisher, first aid kit and smoke and carbon monoxide detectors. LPA tested smoke and carbon monoxide detectors during visit, which were observed to be working.

Capacity limits and ratios for a large family day care have been reviewed with the co-licensee on this date. LPA reminded co-licensee that an assistant must be present when operating as a large license. LPA reminded co-licensee when an assistant is not present, licensee must operate within capacity limits of a small family child care home. LPA reminded licensee co-licensees must be main caregivers for family child care home.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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: POBEREZHNA, ALINA
FACILITY NUMBER: 414005046
VISIT DATE: 10/03/2024
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The licensee has submitted signed Property Owner/Landlord Consent form (LIC9149).

LPA will approve for a capacity of 14 children as of today's date, 10/03/2024.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted.

Exit interview conducted and report was reviewed with the licensee, Alina Poberezhna.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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