434415966-3-16-2021-07-CC-SCOS-BZ6R46-20210316124100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415966
Report Date: 12/09/2020
Date Signed: 03/16/2021 12:41:10 PM

Document Has Been Signed on 03/16/2021 12:41 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:	LAZUTKINA, NATALIA		FACILITY NUMBER:	434415966
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	12/09/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 PM
MET WITH:	Natalia Lazutikina		TIME COMPLETED:	11:00 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	Pp1 Licensing Program Analyst (LPA) Stephanie Collins conducted a scheduled Tele-Pre-Licensing inspection via video conference call with Licensee Natalia Lazutkina . LPA informed Licensee that due to the COVID-19 situation and "Shelter in Place" Order, this LIC809 Facility Evaluation Report was generated at the Licensing Office and will be emailed to Licensee . Licensee 's reply to the email will serve as acknowledgement that the report was received. Licensing Program Analyst (LPA) Stephanie Collins conducted an announced Pre-Licensing inspection of the house today. LPA met with Licensee s Natalia Lazutkina. Licensee Natalia has applied for a license to operate a Large Family Child Care Home with a maximum capacity of 14 at the address listed. The Licensee has satisfied the requirements to apply for a Large Family Child Care Home. A copy of the lease agreement is on file. A Fire Safety Inspection was conducted on 11/24/20. The house has been granted a Fire Clearance with the following comment: "Fire clearance granted for : Dining-room, Play-room, 2 front bedrooms & Play area in backyard; Fire clearance NOT granted for all other area." LPA observed that the home has fully charged 2A,10B:C fire extinguishers, Smoke and Carbon Monoxide detectors. The home’s disaster plan and other required posting were observed as posted, in plan sight. Licensee is advised of the requirement for the home to conduct and document fire and disaster drills at least once every six months. Licensee is reminded that smoking is not allowed in Family Child Care Homes and baby walkers cannot be used for child in care and needs to be kept inaccessible. Days and hours of operation will be Monday through Friday 8:00 AM to 5:00 PM. Licensee has completed 16 hours of training on preventive health practices with Lead exposure, which included pediatric cardiopulmonary resuscitation and pediatric first aid, and one hour on Child Care Nutrition. A copy of the certification is on file. Licensee has documentation on file for Measles, Pertussis, Influenza vaccinations and Certification of Completion of the AB1207 Mandated Reporter Training.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020

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: LAZUTKINA, NATALIA	FACILITY NUMBER: 434415966
	VISIT DATE: 12/09/2020

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

Pp2
Licensee is advised if she decide to not carry liability insurance for their Family Day Care, they must have file of affidavits regarding liability insurance signed by each parent of the children that will be enroll.

LPA toured the indoor and outdoor areas of the home. Off Limit areas in the home are the Master bedroom/bath, one bedroom, laundry room, small storage room and garage. There is a child safety gate preventing access to off limit areas in home. Only during COVID-19 Emergency Protocol and guidelines would Master bedroom bathroom be utilized for sick children. The backyard is fenced and is used for outdoor activity space. Outdoor play equipment and toys were observed to be safe and age appropriate. Note: Off limit areas outside in backyard: The Jacuzzi it has the appropriate tight-fitting cover with locks.

LPA observed safe toys, play equipment and materials in sufficient quantity and age appropriate for day care children. The home is clean and orderly, with heating and ventilation for safety and comfort of children in care. Licensee stated that there are no weapons such as firearm stored on the premises. The home was not observed as having any pets. Detergents, cleaning compounds, sharps, medicines, and other items which could pose a danger if readily available to children were stored where they are inaccessible to children. Licensee is reminded that poisons need to be locked.

Licensee is reminded of her chosen forms of discipline to be used are talking and redirecting the children. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Licensee is reminded that the children have personal rights that cannot be waived or abridged by the licensee regardless of consent or authorization from the child’s authorized representative.

Adults who are over the age of 18 and reside in the home are both Licensee s. They have Criminal Record and Child Abuse Index Clearances, and Tuberculosis Clearance.
Licensee is reminded about the applicable civil penalties for those adults who have not received fingerprint clearances, who are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020

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: LAZUTKINA, NATALIA	FACILITY NUMBER: 434415966
	VISIT DATE: 12/09/2020

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

Pp3
Licensee is reminded of the violations that would result in an immediate assessment of civil penalty in the amount of $500.
Licensee is reminded about the continuing requirements, which include but are not limited to the following topics: (1) Separating sick children when they show signs of illness; (2) Supervision of Children; (3) Capacity Options; (4) transportation of children; (5) Procedures for Reporting Suspected Child Abuse and Unusual Incidents/Injuries; (6) Safe Sleep; and (7) Healthy Beverages in Child Care.
LPA went over the records that need to be maintained at the home with Licensee s. A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the Licensee s. This packet contains information on documents to be made accessible to the Public and documents to be provided to Parents/Legal Guardians. Licensee s are encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.
Licensee is reminded of Incidental Medical Services (IMS) policy was discussed. 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.
Licensee is encouraged to frequent the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of Laws, etc.

COVID-19 Checklist was completed by licensee and submitted to file.

Exit interview was conducted, Licensee 's file will be submitted to Licensing Management for the final stage of review.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3