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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416371
Report Date: 06/16/2021
Date Signed: 06/17/2021 08:17:25 AM

Document Has Been Signed on 06/17/2021 08:17 AM - 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: 0CENSUS: 5DATE:
06/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Ludmila MankovskajaTIME COMPLETED:
12:35 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. Upon arrival of today's inspection, there were 3 three children, whom 2 were infant age and Licensee. Licensee's daughter and son-in-law were also present and were visiting for the day. Two more children arrived shortly after, whom 1 was infant age.

There is board to post required positing. LPA reminded Licensee that Notification of Parent's Rights needs to be posted. The hours of operation are Monday through Friday 7AM to 6PM. There is working phone in the home.

LPA toured the inside and outside of the home. The off-limit areas of the home are the entire upstairs, garage, and walk in closet downstairs. Licensee requested to place bedroom next to the children's bathroom to on-limits. LPA inspected the room. LPA informed Licensee that any ointments or creams need to be inaccessible to children. Licensee stated that she will put the creams away and send a picture of the room to Licensing. Licensee also stated that she will submit an updated LIC 999A: Facility Sketch to reflect the changes to the room. LPA observed that there was a knife on the counter, which is accessible to children, and one of the latches for the cabinet with cleaning supplies was not locked. Licensee latched the cabinet and placed the knife out of reach of children. LPA also reminded Licensee that any creams and razors need to be inaccessible to children. The home was observed to be clean. There are stairs in the home, which were barricaded. There is no fireplace in the daycare area. The furniture and equipment were observed to be age-appropriate and in good condition. There is sufficient amount of toys for the children. There were no baby walkers observed during today's inspection. LPA discussed safe sleep and reminded Licensee about documentation.

--------------------CONTINUES ON 809 DATED 06/16/2021 PAGE 2-------------------------------
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2021
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: 06/16/2021
NARRATIVE
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----------------------CONTINUATION OF 809 DATED 06/16/2021 PAGE 1------------------------

There is fully charged fire extinguisher. LPA reminded Licensee that there needs to be at least one functioning smoke and carbon monoxide detector. The last fire/disaster drill was conducted on 06/08/2021. Licensee stated that there are no firearms, such as weapons, stored in the home.

The backyard is used and is fenced. All play equipment were observed to be in good condition. There were no bodies of water observed during today's inspection. The deck is currently off-limit until it is completed.

Licensee stated that she does not transport children, but understands that children cannot be left alone and unattended in parked vehicles. Licensee also stated that she does not currently provided Incidental Medical Services (IMS). Licensee also understands that children's personal rights cannot be violated, included corporal punishment. LPA also discussed with Licensee about taking children out of play area when they want.

A copy of the facility roster was obtained. 3 children's files were reviewed. The records reviewed include but not limited to Emergency Information Card.

LPA also reviewed Licensee's files. Licensee stated that she has not renewed her Mandated Reporter Training and understands that it requires renewal every 2 years. Licensee stated that she will complete it within 45 days and send proof it to Licensing. Mandated Reported Training can be accessed at http://www.mandatedreporterca.com. Licensee also stated that she completed the CPR/1st Aid, but was unable to show proof. Licensee stated that she will obtain a copy of her CPR/1st Aid card and send it to Licensing. Licensee's immunization records for measles and pertussis are on file; along with her Preventive Health and Safety training.

The adults living in the home are just Licensee. Licensee has cleared criminal records, child abuse index clearance, and TB test. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, 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.

In the areas that were evaluated, two Type B deficiencies have been cited. An exit interview was conducted where this report, citation, plan of correction, and appeal rights were discussed and provided to Licensee. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/17/2021 08:17 AM - It Cannot Be Edited


Created By: Samantha Yip On 06/16/2021 at 11:09 AM
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: 06/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2021
Section Cited
CCR
102417(g)(4)

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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement was not met as evident by:
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Deficiency correct during today's inspection. Licensee moved the knife and locked the cabinet with cleaning supplies.
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Based on observation, LPA observed that there was knife on the counter that was accessible to children and the cabinet with cleaning supplies were not locked. This poses a potential risk to the health and safety to the children in care.
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Type B
08/02/2021
Section Cited
HSC1596.8662(b)(1)

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AB 1207 Mandated Child Abuse Reporting Training. On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider...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 was not met as evident by:
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By POC 08/02/2021, Licensee stated that she will completed the Mandated Reporter Training and send proof of completion to Licensing.
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Based on record reviews, Licensee has not renewed her Mandated Reporter Training two years from when she completed the initial mandated reporter training. This poses a potential risk to the health and safety to the children in care.
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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:Anthony Studebaker
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2021


LIC809 (FAS) - (06/04)
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