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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409560
Report Date: 07/26/2024
Date Signed: 07/26/2024 12:09:01 PM

Document Has Been Signed on 07/26/2024 12:09 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHEVCHENKO, OKSANAFACILITY NUMBER:
073409560
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
07/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Oksana ShevchenkoTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 07/26/24 Licensing Program Analysts (LPA) Mario Caro and Catherine Fernandes met with applicant Oksana Shevchenko and her husband Rumen Gueorguiev to conduct an ANNOUNCED PRELICENSING VISIT. The home was toured to conduct a Health and Safety Inspection. Present during the inspection were the applicant and her husband. LPAs disclosed the purpose of the inspection to the applicant and was granted entry into the facility. This facility plans to operate Monday - Friday, 7:30 am - 6:00pm, depending on the need for care, but will not exceed 24 hours in one day.

Applicant has completed the 8 hour Health & Safety training, Pediatric CPR and First Aid on 03/15/2024, has documentation for Measles, Pertussis immunizations, Influenza and Tuberculosis (TB) clearance (proof in facility file). Applicant completed the mandated reporter training on 03/28/24. Applicant owns the home and submitted a copy of the property tax bill. LPAs reminded applicant that when care for more than six and up to eight is provided, applicant must notify parents.

The home is a single story which consists of three bedrooms, two bathrooms, a kitchen, living/play room, backyard, and a two bedroom converted detached garage. The home is sanitary, safe and orderly, with ventilation for safety and comfort there are floor heaters that have been blocked for the safety of children in care. LPAs observed: a working telephone and working smoke and carbon monoxide detectors. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets. LPAs reminded Applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Applicant states there are no firearms or ammunition stored in the home. LPAs observed age-appropriate toys.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Mario Caro
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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 4
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: SHEVCHENKO, OKSANA
FACILITY NUMBER: 073409560
VISIT DATE: 07/26/2024
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Indoor Space:

ON LIMIT: The living/play room and Master bedroom on left side of the house. The bedroom will be used as a walkthrough space to enter the bathroom in master bedroom.

Off Limits: The kitchen, left half of the master bedroom with walk in closet on the left side of the house, and the entire right side of the house which includes: two bedrooms, a laundry room, bathroom and closet.

Outdoor Space


On Limits: A portion of the backyard is on limits with 100% supervision

OFF LIMIT: The gated areas of the backyard are considered off limits witch includes the far left side and the area behind the converted garage

Isolation area: sitting at the table in the play room.

Discipline policy was discussed, and Applicant stated she will talk to the children as form of discipline. Applicant understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be practiced once every six months and documented. Supervision of children was discussed with the applicant and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times. The licensee understands her capacity options and that she cannot have more than 8 children in the home at any time. Applicant may offer transportation services for children drop off and pick up.

LPAs reviewed with Applicant 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. A Family Child Care Home packet was provided to the Applicant.

LPAs reminded the applicant to report any injuries requiring medical attention or unusual incidents to the Oakland Regional Child Care office.The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.


SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Mario Caro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SHEVCHENKO, OKSANA
FACILITY NUMBER: 073409560
VISIT DATE: 07/26/2024
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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, 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.

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.

LPAs provided the applicant with information on the safe sleep regulations 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. LPAs also informed the 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.

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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Mario Caro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SHEVCHENKO, OKSANA
FACILITY NUMBER: 073409560
VISIT DATE: 07/26/2024
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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.

This home will be ready for licensure once the following items are completed:


A Soft protective covering is placed over the corners of the stone platform in from of the fireplace.
A required size fire extinguisher is purchased.
Immunizations provided for adults living in the home.

Exit interview conducted and report was reviewed with the applicant, Oksana Shevchenko.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Mario Caro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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