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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005611
Report Date: 08/16/2023
Date Signed: 08/16/2023 11:47:19 AM

Document Has Been Signed on 08/16/2023 11:47 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GONCHAROUK, IRINAFACILITY NUMBER:
214005611
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
08/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Irina GoncharoukTIME COMPLETED:
12:00 PM
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On 8/16/2023, Licensing Program Analyst (LPA) Hanson Leong, made a scheduled case management visit to the Family Child Care Home listed above. The Licensee requested a departmental visit to increase capacity from eight (Small License) to fourteen children (Large License). The LPA was granted entry by the Licensee, Irina Goncharouk. The LPA explained the purpose of the visit to the Licensee. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed the Licensee and her two assistants supervising six preschool aged children. Children's capacity and ratio requirements were observed to be in compliance.

LPA and the Licensee both performed a health and safety inspection of the home. The home is clean and safe, with functioning smoke and carbon monoxide detectors as well as a fully charged fire extinguisher. The Licensee has a First Aid Kit at their disposal that is filled, in addition to a thermometer. The home does not have any bodies of water. The trash cans owned by the Licensee have lids that fit tightly and are covered. Toys and equipment that are age-appropriate for the children who are being cared for at the home are always made available to them. The LPA reminded the Licensee not to use baby walkers, bouncers, jumpers, or any other devices of a similar nature.

The Licensee was reminded that parental notification and landlord approval are required if the Licensee provides care for a thirteenth and fourteenth child who is of school age. Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received) are required to be posted in an accessible location where parents can see them.

The San Rafael Fire Department issued a fire clearance for the home on 7/20/2023, as necessary for a Large Family Child Care Home

The LPA will recommend a Large Family Child Care Home License for the Licensee. The large license will take effect on 8/16/2023.

A copy of today’s report and the “Notice of Site Visit” were given to Irina Goncharouk. An exit interview was conducted, and the report was reviewed with Irina Goncharouk.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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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