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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005319
Report Date: 11/21/2025
Date Signed: 11/21/2025 04:45:47 PM

Document Has Been Signed on 11/21/2025 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:OSTROVSKA, OKSANAFACILITY NUMBER:
414005319
ADMINISTRATOR/
DIRECTOR:		OSTROVSKA, OKSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 967-6856
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/21/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Oksana Ostrovska TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On November 21, 2025 @ approximately 9:00 am, Licensing Program Analyst (LPA) Maria Olguin-Leon, conducted an announced, pre-licensing inspection visit. LPA met with applicant Oksana Ostrovska and explained the purpose of the inspection. Applicant submitted a relocation application to Regional Office on November 4, 2025. Applicant was previously licensed at #414004840. Applicant lives in home with spouse. Present during today’s visit was applicant only. All adults living in home have criminal background.
clearances and are associated with facility. Applicant plans to provide care for children 1 yrs old – 10 yrs old. Hours of operation Monday-Friday 8:00am – 6:00pm. Fire inspection clearance was received November 12, 2025.

LPA and applicant inspected the indoors and outdoors of the home for health and safety hazards. Applicant rents home, which consists of living room, family room, kitchen, office, two bedrooms, three bathrooms, hallways, garage, storage unit (in backyard), front yard and backyard. The DAY CARE AREAS: are the family room, living room, kitchen, bedroom #1(napping room), hallways, bathroom #1 and backyard. The OFF-LIMIT AREAS: Office, bedroom #2, storage unit and garage. Applicant was notified that any off-limit areas are not to be used as a day care area without prior approval from the department. LPA observed the following: Family room and Living room are furnished with toy storage cubbies, cubbies for personal belongings, child size furniture, books, play kitchen and learning materials and other age-appropriate toys. LPA observed cubbies secured to wall. Bathroom is equipped with a changing pad, portable potties, stepping stool and children’s toiletry supplies. LPA reminded applicant to clean and disinfect changing mat after diapering children. LPA observed toddler sized beds in napping room with bedding. Applicant provides bedding and will wash weekly or as needed. LPA observed kitchen and bathroom cabinets secured with childproof locks. Off limits rooms are secured with child proof knobs for inaccessibility.

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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: OSTROVSKA, OKSANA
FACILITY NUMBER: 414005319
VISIT DATE: 11/21/2025
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LPA observed all electrical outlets secured with childproof covers. The home is clean and orderly and has proper ventilation and lighting throughout. All detergents, cleaning compounds, medications and other items which could pose a danger are stored inaccessible to children behind child safety locked cabinets. Per applicant, there are no weapons or firearms in the home.

The backyard is enclosed with a 5-ft wood fence and concrete walls. LPA observed a
wrought iron fence on side of home with an additional white gate in back yard for off limits areas. LPA observed off limits areas of yard barricaded with black metal lattice. LPA observed ride on toys, soccer goal, and playhouses in backyard, in good condition. Backyard flooring is cement pavers and artificial grass to absorb and cushion falls. Outdoor decks are equipped with childproof gates. LPA did not observe any spas, pools, or bodies of water in enclosed backyard.

Home is equipped several dual working carbon monoxide/smoke detector. LPA observed a fully charged fire extinguisher (2-A:10 B:C) at entrance of home and is easily accessible. LPA observed a first aid kit fully stocked with necessary supplies. Applicant uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours. The isolation area for sick children will be in the napping room or living room and away from other children and where applicant can supervise all children in care. Applicants’ discipline policy will be redirection, one on one with children and talking to children.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicants CPR/FA expires 03/2027 and Mandated Reporter training expires 03/2027.

LPA and applicant discussed licensing regulations and the capacity requirements. Any children under 10 years of age that live in the home will be counted in overall capacity. LPA reminded applicant they must be present at home 80% of operating hours. Applicant plans to provide a meal service for children in care, which will include breakfast, lunch and am/pm snacks. LPA discussed sanitation and allergies with applicants. LPA reminded Applicant to label all food brought from home.

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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
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: OSTROVSKA, OKSANA
FACILITY NUMBER: 414005319
VISIT DATE: 11/21/2025
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Applicant understands the required emergency disaster drills are to be conducted and documented at least once every six months. Applicant understands that the use of baby walkers, bouncers, jumpers, and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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

The applicant provided proof of control of property.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for and removing 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.

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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: OSTROVSKA, OKSANA
FACILITY NUMBER: 414005319
VISIT DATE: 11/21/2025
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On this date, 11/03/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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

During today’s inspection, applicant provided LPA with the following: original copies of LIC 9149, LIC9151, Flu vaccine and spouse’s TB and updated lease agreement and LIC610A,

LPA will recommend relocation licensure for Large Family Child Care License as of today, November 21, 2025.

Exit interview conducted and report was reviewed with the applicant, Oksana Ostrovska

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC809 (FAS) - (06/04)
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