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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700238
Report Date: 03/23/2023
Date Signed: 03/23/2023 02:30:38 PM

Document Has Been Signed on 03/23/2023 02:30 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:CHELAKHSAEVA, EMMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 922-7512
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Emma Chelakhsaeva- LicenseeTIME COMPLETED:
02:40 PM
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On 3/23/23 at 1:05pm, Licensing Program Analysts Briana Plumboy and Andrew Elliott met with licensee Emma Chelaksaeva for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was 1 infant, 8 preschool age children, and fingerprint clear and associated 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 toys that are safe and appeared to be clean. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. 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 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 for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CHELAKHSAEVA, EMMA
FACILITY NUMBER: 015700238
VISIT DATE: 03/23/2023
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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 2/4/23.
6 children files were reviewed, facility roster reviewed and copy obtained. 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.

No deficiencies cited during today's inspection. 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: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC809 (FAS) - (06/04)
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