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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700388
Report Date: 10/05/2022
Date Signed: 10/05/2022 10:54:57 AM

Document Has Been Signed on 10/05/2022 10:54 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:BENKO, MARIYAFACILITY NUMBER:
015700388
ADMINISTRATOR:BENKO, MARIYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 368-3821
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
10/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mariya Benko TIME COMPLETED:
11:00 AM
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On 10/5/2022, approximately at 9:00AM, Licensing Program Analyst Kelly Phan met with applicant Mariya Benko for unannounced case management visit for location change from 585 S Murphy Avenue, Sunnyvale, CA 94086 (#434414715) to 4475 Amador Road, Fremont CA 94538. Presented during today's health and safety inspection was just the applicant and her two young children (3 1/2 and 1 1/2). Also residing in the home is the applicant's fingerprinted and associated husband. Hours of operation will be Monday to Friday between 8AM to 6PM.

The applicant's home is a two story home that is neat and clean with heating and ventilation to provide safety and comfort . The home has a fully charged 3A40BC fire extinguisher, working carbon monoxide, smoke detectors, and working telephone. LPA reviewed a mortgage statement that shows applicant owns the property. The areas of the day care will consist of study room, eating area, bathroom in the eating area, first right side bathroom (for day care staff only), bedroom #1 (boy's room/isolation area), bedroom #2 (girl's room), fenced backyard, and right side yard (main entry for day care). There were ample age appropriate toys and activities for children to utilize. In one bedroom #2, LPA observed that there was a heat vent that was not covered; LPA suggests to applicant to cover the area as it may cause harm if children were to play in or around it; Applicant understood and states that she would provide a cover on it. LPA suggests sending a picture of the covering via email or text message. Applicant also states that she would only turn on their heating system before operating hours to warm up the room and turn it off once children arrive. The facility does not have a fire place; they do have a heater that is inaccessible to children as there is a closed door. The "OFF LIMIT" areas are kitchen, garage, hall, left side yard, outdoor shed, and entire second floor. OFF LIMIT areas have a barrier/gate/curtains to prevent access to those areas. At 9:30am, the backyard play area was observed and is free from defects or dangerous conditions as applicant has padding around the area. There are no pools, hot tubs or any other bodies of water on the premises. The backyard area also has space to run and play with cars and sandbox; applicant states that there is no sand in it right now; LPA observed there is a covering for the sandbox to prevent any sharp items. Per licensee, there are no pets or firearm or no one who smokes at the home. All hazardous materials and toxins are out of the reach of children. SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: BENKO, MARIYA
FACILITY NUMBER: 015700388
VISIT DATE: 10/05/2022
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At 10:00AM, LPA reviewed the facility file with applicant. Applicant has completed the preventive health and safety training, CPR and First Aid certificates are valid from 12/18/21 until 12/18/2023 from American Red Cross. Applicant also has completed the Mandated Reporter training on 09/22/2021 and have required immunizations. Applicant's fingerprinted and associated husband also has required immunizations on file. There are required forms posted for public review such as emergency disaster plan with facility sketch plan; Applicant has not completed fire drill yet as she has just moved to the area about 2 months ago. LPA suggests applicant to start conducting fire drills once she has children at her facility. Facility also has liability insurance on file.

Day care is permitted in the garage. Facility received fire clearance on 09/26/2022 to operate as a large family child care. This home is recommended for licensure on 10/05/2022. This report shall remain on file for 3 years. Exit interview conducted and appeal rights were given with applicant, Mariya Benko.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
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: BENKO, MARIYA
FACILITY NUMBER: 015700388
VISIT DATE: 10/05/2022
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

Incidental Medical Services (IMS) policy was discussed. 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.”

LPA discussed the safe sleep regulations with applicant 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 APPLICANT 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC809 (FAS) - (06/04)
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