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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005611
Report Date: 06/18/2024
Date Signed: 06/18/2024 01:12:03 PM

Document Has Been Signed on 06/18/2024 01:12 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GONCHAROUK, IRINAFACILITY NUMBER:
214005611
ADMINISTRATOR/
DIRECTOR:
GONCHAROUK, IRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 990-3911
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Irina GoncharoukTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 6/18/2024, Licensing Program Analysts (LPAs) Leong and Van conducted an unannounced annual visit to the Family Childcare Home (FCCH) listed above. LPAs met with the Licensee, Irina Goncharouk, and explained the purpose of the visit. Eleven children (ten pre-k and one infant) and three adults were present during the visit. The three adults present at the FCCH received criminal record clearance from the department. The FCCH is within its capacity and in accordance with the required ratio of staff to children.

LPAs observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed in a prominent, publicly accessible location.

The last emergency disaster drill was conducted on 12/4/2023 and properly recorded. LPA reviewed the emergency disaster drill log and found that they were conducted every six months.

Daycare Areas: Side Entrance, Bedroom (Napping only), Living room, Kitchen/Dining Area, Backyard and Bathroom #1 and Bathroom #2

Off Limit Areas: Closets. The licensee understands that off-limits areas may not be used for childcare during business hours.

LPA conducted an inspection for potential health and safety hazards and found the home's interior to be clean and orderly, with proper heating and ventilation for safety and comfort. According to the licensee, she provides food and snacks for the children. LPAs reminded the licensee about the importance of sanitation and proper food preparation. The FCCH was observed to have a first aid kit, functioning smoke and carbon monoxide detectors, and a fully charged fire extinguisher.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GONCHAROUK, IRINA
FACILITY NUMBER: 214005611
VISIT DATE: 06/18/2024
NARRATIVE
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LPA observed that the indoor daycare areas were equipped with age-appropriate toys, furniture, and educational materials. No equipment, such as walkers, bouncers, or similar objects, was present in the FCCH. The FCCH was observed with individual permanent or portable storage space for the children’s clothing and personal belongings. Electrical outlets were observed to be properly covered with child safety covers

According to the licensee, no firearms or weapons are on the premises. Poisons, detergents, cleaning compounds, and other items that could pose a danger were observed in the kitchen cabinets, secured with child safety latches, making them inaccessible to the children.

The outdoor playground was enclosed by a fence, and the play equipment was well-maintained. The areas around and under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs falls. No bodies of water, such as pools or spas, were present on site.

The bathrooms were found to be clean and fully operational. The toilets and handwashing facilities were well-kept, safe, and clean.

The sleeping/resting area was observed to be clean and sanitary. There were cots, cribs, blankets, and sheets available for children to use. LPA also observed that the infant mattresses were firm and appropriately covered with a fitted sheet appropriate to the child’s size.

LPA reviewed five children’s files and confirmed that all five children have complete files that include their emergency contact and medical information.



LPA reviewed the licensee’s files and confirmed that all required forms were present. LPA found that the licensee possesses a current Pediatric First Aid/CPR certification expiring on 5/2026. LPA reminded the licensee to maintain immunization records in the staff files.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GONCHAROUK, IRINA
FACILITY NUMBER: 214005611
VISIT DATE: 06/18/2024
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Licensee was reminded that all adults 18 and over living or working in the home, 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 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On this date, 6/18/2024, 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.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GONCHAROUK, IRINA
FACILITY NUMBER: 214005611
VISIT DATE: 06/18/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies were issued today during LPA's visit.

A copy of today's report was given to the Licensee, Irina Goncharouk. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Irina Goncharouk.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
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