<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413945
Report Date: 07/27/2021
Date Signed: 07/27/2021 12:17:01 PM

Document Has Been Signed on 07/27/2021 12:17 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VENZON, NATALYAFACILITY NUMBER:
434413945
ADMINISTRATOR:VENZON, NATALYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 603-5656
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Alena Klimovich ( Assistant ) TIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Pete Hernandez met with Assisitant Alena Klimivich and conducted Required 1 Year inspection. Licensee was not home when LPA arrived and is on vacation. Licensee is expected to return next week. Assistant contacted Licensee. Also Present was Assistant Ianina Titoruk. Natalya and informed her of LPA’s arrival. Present were 12 preschool children under the care of the two assistants. Licensee, spouse and her Son are the adults living the home, along her two minor daughters. Child care operation hours M-F, 7:00 AM to 7:00PM. Licensee owns home. LPA observed posting of the License, Emergency Disaster Plan, Parents’ Rights information, and Earthquake Preparedness checklist.
LPA will perform a physical plant inspection and review the children's files but will need to return at a future date to complete the inspection with the Licensee.

LPA toured the indoor and outdoor areas. Off limit areas inside the home are: Kitchen, living room, 2 bedrooms, 2 bathrooms, laundry room, basement, and garage which are all barricaded to make them inaccessible to the children. Also off limits is the office/ master bedroom, which is connected to the On Limits area but is closed.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 7/27/2021):
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VENZON, NATALYA
FACILITY NUMBER: 434413945
VISIT DATE: 07/27/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 7/27/2021):
Off-limit areas outside: the right side yard, which is barricaded with a fence. Licensee acknowledged that children may never enter these off-limit areas. The backyard is adequately fenced. LPA observed no bodies of water on the property and Licensee has a waiver on file for her water fountain that is filled with rocks. Licensee states that there are no weapons in the home. There is a barricaded fire place in the home. All cleaning materials, hazardous items and medications are all inaccessible to children. LPA observed a fully charged 2A10BC fire extinguisher, and working smoke/carbon detectors and fire pull stations. LPA was unable to review the fire drill log. All cleaners and poisons were locked up or out of reach of the children.
LPA reviewed the files of the seven of the twelve enrolled children. All of the reviewed files have the required documentation. All the children's files were complete and contained the necessary documentation.

A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.
REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 7/27/2021):
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VENZON, NATALYA
FACILITY NUMBER: 434413945
VISIT DATE: 07/27/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 7/27/2021)Supervision of children was discussed. Assistant understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are supervised at all times.( For the purposes of this inspection report, LPA Pete Hernandez notes that the Licensee has and is allowed to have Assistant coverage while on her vacation so long as the Assistants are qualified and associated to the License.) The Licensee understands her capacity options. The Licensee states that she does not transports children in her vehicle regularly. She understands that children cannot be left in parked vehicles unattended at any time and must have the appropriate car seats for each child.
Incidental Medical Services (IMS) policy was discussed. Licensee stated she does not administer IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov
The Mandated Reporter Training (AB1207) can be completed at the website listed. http://www.mandatedreporterca.com/
No deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, An exit interview was conducted and a copy of this report and appeals rights were discussed and left for the Licensee, Assistant Alena Klimovich , whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3