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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005046
Report Date: 10/25/2024
Date Signed: 10/25/2024 03:03:33 PM

Document Has Been Signed on 10/25/2024 03:03 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:		POBEREZHNA, ALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 308-6511
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Licensee, Alina PoberezhnaTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On October 25, 2024 at approximately 1:30pm, Licensing Program Analyst (LPA) Melissa Zaragoza, conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee, Alina Poberezhna. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included Licensee, 1 staff assistant, and 5 children (preschool children).

Hours of operation are Monday through Friday 8:00am to 6:00pm. Licensee lives in a one-level home with their spouse and 2 children. All adults living in the home and staff present, have fingerprint clearance on file.

The DAY CARE AREAS are the living room, bedroom #1 (napping room), bathroom #1, playroom, and part of the backyard yard. The OFF LIMIT AREAS are the kitchen, bedroom #2, bedroom #3, bedroom #4, bathroom #2, and the garage. Off limit areas are made inaccessible with child safety gates.

LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed electrical outlets to be made inaccessible with child safety covers. LPA observed heaters on the floor to have heater covers. Cleaning supplies, poisons and hazardous materials are stored in home's high shelves and/or in homes off limit areas.

Home is equipped with a fully charged fire extinguisher and a smoke and carbon monoxide detector. Smoke and carbon monoxide detector was tested during visit and was observed to be in working condition. There are no pools, and bodies of water in the premises.

Napping room (room space) was observed to be equipped with beds for napping children. LPA observed beds to have mattresses with tight fitting sheets. Per licensee, they provide sheets, and parents take them home and wash. Blankets are washed weekly or when needed.

LPA observed the bathroom. Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. Per licensee, children’s families provide diapers and wipes for enrolled children.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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 3
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: 10/25/2024
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Children eat in living room. A food service is provided to children that include breakfast, lunch, dinner, and snack. LPA observed eating area to be clean and equipped with appropriate dining furniture. Per licensee, there are no children with dietary restrictions or allergies. LPA observed knives to be made inaccessible in kitchen. Kitchen is off limits with a child safety gate.

Outdoor area in the back yard is entirely enclosed and fenced. Outdoor area includes a variety of toys and equipment that were in good condition. LPA observed an at home play structure. LPA observed a sandbox in backyard, with a roof top, and cover. LPA observed backyard to have fake grass flooring, under the play area. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 5 children's records which were complete. LPA reviewed licensee’s and staff records, which were complete. Licensee has a current CPR/First Aid certification and current Mandated Reporter certification. Licensee's CPR/First Aid certification will expire 6/2026 and Mandated Reporter certifications will expire 8/18/25.

Emergency disaster drills are conducted and are appropriately documented. Last disaster drill was conducted 7/1/24. LPA observed licensing documentation to be properly posted, made available for review. Facility maintains a childcare roster that was also made available for review. Per licensee, there are no weapons or firearms in the home.

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 CARE tools, please send email inquiries 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/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 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.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 10/25/2024
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Alina Poberezhna, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed a Megan’s Law search on 10/25/2024.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

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: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC809 (FAS) - (06/04)
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