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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418512
Report Date: 01/18/2024
Date Signed: 01/18/2024 11:04:56 AM

Document Has Been Signed on 01/18/2024 11:04 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:YAROSHEVSKAYA, ANNAFACILITY NUMBER:
013418512
ADMINISTRATOR:YAROSHEVSKAYA, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 828-3071
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
01/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Licensee,Yaroshevskaya, AnnaTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Anna Yarosherskaya for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the helper. Present during this inspection was Licensee, her mother supervising nine (9) preschoolers. The Licensee is within the capacity limits of a Large License. The Licensee lives in the home with her husband. The home is two-story with four bedrooms and two and a half bathrooms, a family room, a living room, a kitchen, a dining room, a garage, and a back yard. The hours of operation are 7:00 AM- 6:00 PM, Monday -Friday.
ON-LIMIT AREAS: family room( main daycare area) and a half bathroom( next to garage door) backyard.
OFF-LIMIT AREAS are the entire second floor, kitchen, dining room, living room, and garage. All the off-limit areas are made inaccessible to children by locked doors, safety gates, and visual supervision.
LPA observed the following: The Daycare Area is clean, orderly, and equipped with age-appropriate toys. The home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water or Fireplace in the Daycare area. There are child-size tables and chairs for snacks and activities.The licensee provides cots, and children bring their own blankets and sheets. The blankets and sheets are washed weekly by the Parents.A child safety gate is located at the bottom of the stairs to prevent access to the stairs and upper levels for children in care. The outdoor area has age-appropriate toys and furnishings and is free from defects and dangerous conditions. The Licensee states there are no guns or weapons of any kind in the home. The Licensee and helper's CPR expires in 03/2024. The Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children's files. All the files are complete and up to date. The Licensee was reminded about the infant's sleep checks; however,the facility has no infants enrolled. All required postings are properly posted.
See next page...
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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Document Has Been Signed on 01/18/2024 11:04 AM - It Cannot Be Edited


Created By: Jyoti Saini On 01/18/2024 at 09:44 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: YAROSHEVSKAYA, ANNA
FACILITY NUMBER: 013418512

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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: (4) 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 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. The children's bathroom cabinet has stored cleaning compounds, and the child-proof latch has worn out, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
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Licensees shall purchase and install new latches or move cleaning compounds from there, making them inaccessible to the children in care. The Licensee shall submit the proof of correction to the LPA via email.
Type B
Section Cited
CCR
102417(g)(9)(A)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above. The Licensee did not have a complete disaster drill( fire and earthquake) log. Furthermore, LPA observed the Licensee updating the disaster drill log during the inspection, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 01/25/2024
Plan of Correction
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Licensees to conduct a disaster drill (fire or earthquake) and, from now on, complete a drill at least once every six months.
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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YAROSHEVSKAYA, ANNA
FACILITY NUMBER: 013418512
VISIT DATE: 01/18/2024
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During Inspection, Licensee 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 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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Two deficiencies and one technical violation were given today. ( see attached LIC809-D)



A notice of site visit was given and must remain posted for 30 days.

Appeal rights were given.

Exit interview conducted and report was reviewed with the licensee, Anna Yaroshevskaya.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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