434413945-9-25-2024-07-CC-SYIP-D9FU56-20240925151610

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413945
Report Date: 09/25/2024
Date Signed: 09/25/2024 03:17:14 PM

Document Has Been Signed on 09/25/2024 03:17 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, NATALYA		FACILITY NUMBER:	434413945
ADMINISTRATOR/ DIRECTOR:	VENZON, NATALYA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 603-5656
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	09/25/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:22 AM
MET WITH:	Natalya Venzon		TIME VISIT/ INSPECTION COMPLETED:	02:20 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) Samantha Yip conducted an unannounced Annual/Random inspection. Licensee arrived around 11:33AM. LPA met with Licensee and explained the reason for the inspection. Present during today's inspection were Licensee, two assistants, and 10 children. There is a board to post required postings, such as license and notification of parent's rights. Licensee has a waiver for her water fountain, which was posted. The hours of operation are Monday through Friday 8:30AM to 6PM. Licensee only cares for children 3-5 years old. LPA toured the inside and outside of the home with Licensee. The off-limit areas of the home are the bedroom next to the dining room, two bedrooms next to the kitchen, kitchen, living room, and garage. There is a fireplace that was barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. LPA discussed with Licensee that any disinfectant wipes and medication, such as epi-pen, allergy medication, or pain relievers, needs to be inaccessible to children. There are toys and equipment for children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, stored on the premise. The backyard is used and is fenced. The off-limit areas outside are both sides of the yard. There is a play structure, which is anchored to the ground. There were no bodies of water observed during today's inspection. -----------------CONTINUES ON 809 DATED 09/25/2024 PAGE 2-----------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VENZON, NATALYA	FACILITY NUMBER: 434413945
	VISIT DATE: 09/25/2024

NARRATIVE

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---------------CONTINUATION OF 809 DATED 09/25/2024 PAGE 1--------------

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. There is instructions from the parents regarding the medication, but no written consent from the parent for the family child care home to administer medication, nor the physician's order. The date on the epi-pen does not match the date on the box. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Seven (7) children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and LIC 700. LPA observed that three parents did not sign the LIC 700 form and three children needed their immunization records to be transferred to the PH 286.

Licensee and her assistant's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and Mandated Reporter training. Licensee and her assistant have immunization records for measles and pertussis. LPA discussed with Licensee to keep record of influenza or a statement that the flu shot was declined in file. LPA also discussed with Licensee that the Mandated Reporter training needs to be renewed every two years. Licensee and her assistant did not have mandated reporter training certificate in file. A-1's CPR/1st Aid expires on 07/08/2025.

-----------------CONTINUES ON 809 DATED 09/25/2024 PAGE 3---------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VENZON, NATALYA	FACILITY NUMBER: 434413945
	VISIT DATE: 09/25/2024

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------------CONTINUATION OF 809 DATED 09/25/2024 PAGE 2----------------

The adults 18 and over living in the home are Licensee, her husband, and her adult child. Licensee also has one minor child. 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.

During the exit interview, the Licensee, Natalya Venzon, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; 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.

An updated LIC 279 was obtained during today' inspection.

Licensee will submit the following:
- parent consent and physician's order for C-1
- Mandated Reporter training certificate
- facility roster
- proof of daycare insurance

As a result of this inspection, Type B citations were issued. Exit interview conducted and report was reviewed with Licensee Natalya Venzon. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/25/2024 03:17 PM - It Cannot Be Edited

Created By: Samantha Yip On 09/25/2024 at 01:38 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VENZON, NATALYA	FACILITY NUMBER: 434413945
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in three out of three persons, which poses a potential health, safety or personal rights risk to persons in care. Licensee and her assistant have not completed Mandated Reporter training. Her assistants are waiting training to be conducted in Russian.
	POC Due Date: 11/12/2024
	Plan of Correction
1 2 3 4	By POC 11/12/2024, Licensee and her assistant will completed Mandated Reporter training and submit proof to Licensing.

Type B

Section Cited

CCR

102419(d)

Admission Procedures and Parental and Authorized Representative's Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two out of seven persons, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/02/2024
	Plan of Correction
1 2 3 4	By POC 10/02/2024, Licensee will have parents fill out LIC 999A and send proof to Licensing.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Joel Segura

LICENSING EVALUATOR NAME:

Samantha Yip

LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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