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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409430
Report Date: 08/22/2023
Date Signed: 08/22/2023 11:00:59 AM

Document Has Been Signed on 08/22/2023 11:00 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ZALAZAEVA, ELENAFACILITY NUMBER:
073409430
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/22/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Elena ZalazaevaTIME COMPLETED:
11:10 AM
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On August 22, 2023, at 930am, Licensing Program Analyst (LPA) Randall Dunevant and Licensing Program Manager (LPM) Loretta Dyson conducted an announced Pre-licensing inspection and met with applicant Elena Zalazaeva. LPA disclosed the purpose of the inspection and was granted entry into the facility by the applicant. Residing in the home are the Applicant and husband, and two young children. Applicant, Husband and one young child where present during the inspection. The facility was toured to conduct a health and safety inspection. The Applicant plans to operate Monday through Friday from 730am to 545pm.

This home is a single-story house consisting of 3 bedrooms, two bathrooms, a living room, dining room, kitchen, and garage, and playroom. There is also a large fully fenced backyard. The home was observed to be neat and clean with heating and ventilation for safety and comfort of the children.

On-limit-areas are: The sleeping room to the right of the front door, the bathroom across from the sleeping room, and the playroom at the rear of the home next to the rear exit of the home.

Off-limit-areas are: The living room, dining room, kitchen, master bedroom, 3rd bedroom down and its large closet the next to the sleeping room, master bathroom, and the backyard portion that is not contained in the fenced off play area.

Outdoor play area: Large fenced off play area for children in the back yard, fenced off with a small white fence.

Isolation area: In the corner of the sleeping room away from other children in care.

There are age-appropriate toys which are observed to be safe, clean and in good repair. The Applicant plans on providing Lunch and two snacks to the children. There are no bodies of water or pools accessible to children in care during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There's a fireplace in the living room that is blocked to prevent children access. Per Applicant there is a firearm in the home the weapon is properly stored per regulations. The Applicant will not be providing Overnight Care. Off limits areas are made inaccessible by closed and/or locked doors, gates, and visual supervision.

The home has a fully charged 2A10BC fire extinguisher in the kitchen, a working smoke detector in the kitchen and sleeping rooms, and a plug-in carbon monoxide detector in the playroom, and a working telephone. The applicant’s CPR certificate expires on 5/2025 and the Mandated Reporter Certificate expires on 5/2025. The Applicant has does not have Liability Insurance.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Randall Dunevant
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ZALAZAEVA, ELENA
FACILITY NUMBER: 073409430
VISIT DATE: 08/22/2023
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Elena Zalazaeva 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Elena Zalazaeva provided proof of control of property.

Elena Zalazaeva rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord.

Elena Zalazaeva has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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 reviewed with Elena Zalazaeva the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. PIN 22-05-CCP Page Eight

LPA discussed the safe sleep regulations with Elena Zalazaeva and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Elena Zalazaeva f 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.

On this date, 7/12/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Randall Dunevant
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ZALAZAEVA, ELENA
FACILITY NUMBER: 073409430
VISIT DATE: 08/22/2023
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Elena Zalazaeva was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Exit interview conducted and report was reviewed with the Elena Zalazaeva license will be effective today 8/22/2023.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Randall Dunevant
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC809 (FAS) - (06/04)
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