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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700366
Report Date: 08/15/2022
Date Signed: 08/15/2022 10:50:59 AM

Document Has Been Signed on 08/15/2022 10:50 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:DZHYLIALOVA, NIIARAFACILITY NUMBER:
435700366
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Niiara DzhylialovaTIME COMPLETED:
11:00 AM
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On Monday 08/15/2022, at approximately 9am Licensing Program Analyst Sabina Dodoo, met with Licensee Niiara Dzhylialova, to conduct an Announced Pre-Licensing Inspection. Present during the inspection was Licensee Niiara Dzhylialova, licensee’s nephew Kyrylo Oliinyk and the nephew’s wife Anastasiaa Oliinyk. Licensee, licensee’s nephew and the nephew’s wife are all fingerprint cleared and associated. Also present was Licensee’s translator Oleksandr Mishyn.

The home is a two- story residential house without a garage. Licensing Program Analyst and Licensee toured the inside and outside of the home to conduct a health and safety inspection. The first floor of the home consist of a living room(Converted into an activity room), a kitchen, a dining area, a hallway bathroom, and a master bedroom with a bathroom. The second floor of the home consist of 2 bedrooms, a hallway bathroom, and a master bedroom with a bathroom. The home has a working smoke detector, a working carbon monoxide detector and two fully charged fire extinguisher 2A 10 40 BC. The home has adequate heating and ventilation for the safety and comfort of children in care. Per licensee there are no firearms in the home. Licensee has a current copy of a lease and CPR/ First Aide is current from 01/29/2022 to 01/29/2024. After a review of the file the applicant has completed the Mandated Reporter Training which will expire on 02/09/2024. Licensee is adhering to the immunization laws as it is required for all day care providers.

Per Licensee the operating hours of the Family Child Care Home will be Monday through Friday from 8am to 6pm.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: DZHYLIALOVA, NIIARA
FACILITY NUMBER: 435700366
VISIT DATE: 08/15/2022
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Licensee has requested the following rooms to be ‘on limits’ to day-care children: living room(day care activity room), dining area, hallway bathroom, 2 bedrooms located on second floor and the entire backyard.

Licensee has requested the following rooms be ‘off limits’ to day-care children: master bedroom with master bathroom on first floor, the kitchen area, the upstairs bathroom, and the upstairs master bedroom with bathroom .

Licensee has child proof gates present and affixed at the beginning of the stairs leading to the second floor. LPA Dodoo, discussed and reiterated documents that go into a child’s facility file and documents which are to be posted for parental view. There are no bodies of water on the premises.

Licensee Niiara Dzhylialova, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA Sabina Dodoo, discussed the safe sleep regulations with licensee Niiara Dzhylialova, 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.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

This home is being recommended for licensure.

Exit interview conducted and report was reviewed with the licensee Niiara Dzhylialova.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC809 (FAS) - (06/04)
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