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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700238
Report Date: 03/23/2022
Date Signed: 03/23/2022 01:15:23 PM

Document Has Been Signed on 03/23/2022 01:15 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHELAKHSAEVA, EMMAFACILITY NUMBER:
015700238
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Emma Chelaksaeva- LicenseeTIME COMPLETED:
01:25 PM
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On 3/23/22 at 11:33am, Licensing Program Analyst Briana Plumboy, met with licensee Emma Chelaksaeva for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was 1 infant, 7 preschool age children, 1 school age child, and fingerprint clear and associated assistant Halyna Sernetska. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from Monday through Friday from 7:00am until 6:00pm.
The home is single story. The home consists of a laundry room, 3 bedrooms, dining room, a master bedroom with bathroom, a living room, and a hallway bathroom. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the first bedroom on the right side of the hallway, laundry room, and master bedroom with master bathroom which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the hallway bathroom, the last bedrooms on the left and right side of the hallway, the dining room, and the living room. The ISOLATION AREA will be the bedroom at the end of the hallway on the right. Outdoor play area will be in the fenced backyard. The left and right sides of the home in the backyard are off limits to children in care and have gates to prevent access to them. The outdoor play area is free from defects or dangerous conditions during today's inspection. There is a deck/patio are which is on limits to children in care, then 2 steps down which lead to the second play yard. There is also a pull out shade on the deck/patio area. There are ample age appropriate toys that are safe and appeared to be clean. There are no pools, hot tubs or any other bodies of water on the premises. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection.
The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificate is current and expires 4/11/23, and assistant Halyna Sernetska's CPR and First Aid expires on 03/02/24. The licensee's mandated reporter training is complete and she received a certification of completion on 4/23/21, assistant Halyna currently has a waiver from the mandated reporter training until the training is available in Russian which is her primary language. The facility has current daycare insurance. The licensee and assistant present are in compliance with immunization law which pertains to day care providers. There are floor heaters which do not get hot to touch and are covered to prevent access to children in care.
See 809-C and 809- for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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: CHELAKHSAEVA, EMMA
FACILITY NUMBER: 015700238
VISIT DATE: 03/23/2022
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Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 12/01/21.
5 children files were reviewed, facility roster reviewed and copy obtained. The licensee provided LPA Plumboy with a sleep chart which she utilizes to document the times she checks on the infants while they are asleep. The licensee is out of ratio today and over capacity. All REQUIRED forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. 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
Pe licensee, there are no children currently enrolled who require IMS

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Emma Chelaksaeva 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 Emma Chelaksaeva 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.

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

See 809-D for deficiency regarding capacity during today's inspection. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Emma Chelaksaeva.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/23/2022 01:15 PM - It Cannot Be Edited


Created By: Briana Plumboy On 03/23/2022 at 12:45 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHELAKHSAEVA, EMMA
FACILITY NUMBER: 015700238

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and physical census, the licensee did not comply with the section cited above due to 9 children in care during todays inspection with the license capacity of 8 (1 infant, 7 preschool age children, and 1 school age child) which poses an immediate health, safety risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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Licensee is to immediately reduce numbers to within capacity and ratio specified on license and watch the ratio/capacity video on the ccld.ca.gov website and submit a summary to LPA Plumboy via email. LPA to revisit to ensure Licensee is remaining within RATIO. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Wynn Norona
LICENSING EVALUATOR NAME:Briana Plumboy
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022


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