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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416371
Report Date: 09/06/2023
Date Signed: 09/06/2023 04:15:36 PM

Document Has Been Signed on 09/06/2023 04:15 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:MANKOVSKAJA, LUDMILAFACILITY NUMBER:
434416371
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
09/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Ludmila MankovskajaTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required 1 Year inspection. LPA met with Licensee Ludmila Mankovskaja and explained the reason for the inspection. Licensee is also applying for change of capacity to be a large Family Child Care Home (FCCH). Licensee has at least one year of experience as a licensed FCCH. A fire clearance was granted on 08/29/2023. Present during today's inspection were Licensee and three children, whom one was infant age. Licensee's daughter and grandchild arrived later. The hours of operation are Monday through Friday 7:30AM to 6PM

LPA toured the inside and outside of the home. The off-limit areas of the home are the bedroom located next to the bathroom on the lower level, garage, and the entire upper level. The bathroom on the lower level is temporarily off-limits. Licensee understands that all products in the bathroom that states to keep out of reach of children needs to be inaccessible to children. LPA discussed with Licensee about installing a lock. There are stairs in the home. There is a gate placde before the stairs. Licensee understands that if she uses the bathroom on the lower level that the stairs need to be barricaded. 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. Licensee does have pets. Licensee does not transport children, but understands that children cannot be left alone and unattended in parked vehicles.

The off-limit areas outside are the right side of the deck and the patio to the right of the stairs. LPA observed that the stairs that lead to the driveway was not barricaded. Licensee blocked the stairs during inspection. The outside area is fenced. 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 09/06/2023 page 2----------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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: MANKOVSKAJA, LUDMILA
FACILITY NUMBER: 434416371
VISIT DATE: 09/06/2023
NARRATIVE
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------------------continuation of 809 dated 09/06/2023 page 1-------------------

LPA observed that the door to the room children were napping was closed and there was blanket in the playyard that the infant was napping in. Licensee removed blanket during today's inspection and keep the door open. Licensee sits with the children when they are napping, but does not document the time that she checks them. Licensee started to document sleep checks during today's inspection. LPA discussed the safe sleep regulations with licensee 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 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Licensee does not have written permission from parent to administer medication and physician's order. 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/.

Three children's files were reviewed during today's inspection. The records reviewed include but not limited to LIC 995A and immunization records. C-1 did not have immunization record.

Licensee has a valid CPR/1st Aid, which expires on 04/2025. Licensee completed the Mandated Reporter training on 07/26/2023. Immunization records for measles and pertussis and her preventive health and safety training certificate are on file.

------------------continues of 809 dated 09/06/2023 page 3-------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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: MANKOVSKAJA, LUDMILA
FACILITY NUMBER: 434416371
VISIT DATE: 09/06/2023
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-----------------continuation of 809 dated 09/06/2023 page 2----------------------

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home.

The adults 18 and over living in the home are Licensee, her adults daughter, and son-in-law. Licensee's minor grandchild also lives in the home. 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.

-----------------continues on 809 dated 09/06/2023 page 4------------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/06/2023 04:15 PM - It Cannot Be Edited


Created By: Samantha Yip On 09/06/2023 at 03:21 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: MANKOVSKAJA, LUDMILA
FACILITY NUMBER: 434416371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which posed a potential health, safety or personal rights risk to persons in care. Stairs outside that lead to the driveway was not barricaded.
POC Due Date: 09/13/2023
Plan of Correction
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Deficiency was corrected during today's inspection. Licensee barricaded the stairs during today's inspection.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care. There was a blanket in the playyard.
POC Due Date: 09/13/2023
Plan of Correction
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Deficiency was corrected during today's inspection. Licensee removed the blanket during today's inspection.
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: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/06/2023 04:15 PM - It Cannot Be Edited


Created By: Samantha Yip On 09/06/2023 at 03:21 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: MANKOVSKAJA, LUDMILA
FACILITY NUMBER: 434416371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care. The door to the room the infant was sleeping in was closed.
POC Due Date: 09/13/2023
Plan of Correction
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Deficiency was corrected during today's inspection. Licensee opened the door to the room that the infant was sleeping in.
Type B
Section Cited
CCR
102425(j)(2)(D)
The provider shall check and document the following: Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: a. Date. b. Infant’s name. c. Time of each 15-minute check.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of one persons, which posed a potential health, safety or personal rights risk to persons in care. Licensee will sit with the children in the room, but does not document the time she checked the infant.
POC Due Date: 09/13/2023
Plan of Correction
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Deficiency was corrected during today's inspection. Licensee started to document the sleep checks during today's inspection.
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: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023


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: MANKOVSKAJA, LUDMILA
FACILITY NUMBER: 434416371
VISIT DATE: 09/06/2023
NARRATIVE
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------------------continuation of 809 dated 09/06/2023 page 3------------------

During the exit interview, the Licensee, Ludmila, 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.

Licensee will submit the following:
- proof of property (ig: montage, deed, or property tax)
- TB test for A-1 and A-2
- liability insurance
- C-1's immunization record
- written permission from parent and physician's order for C-2
- Plan for Providing IMS

As a result of this inspection, Type B citations were issued. Exit interview conducted and report was reviewed with the licensee Ludmila Mankovskaja. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
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