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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313625793
Report Date: 06/11/2024
Date Signed: 06/11/2024 08:01:32 AM

Document Has Been Signed on 06/11/2024 08:01 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MARCHUK, NASTASSIAFACILITY NUMBER:
313625793
ADMINISTRATOR/
DIRECTOR:		MARCHUK, NASTASSIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 633-4845
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:15 AM
MET WITH:Nastassia Marchuk - ApplicantTIME VISIT/
INSPECTION COMPLETED:
08:15 AM
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Licensing Program Analyst (LPA) Owens met with applicant for a pre licensing inspection. Applicant speaks Russian. LPA use Google Translate to communicate with applicant. Applicant speaks some English. Present at time of inspection was applicant. LPA toured the home inside and out, and reviewed forms for children's records. Applicant rents the home and has the necessary Landlord notification and consent forms on file. LPA explained about obtaining $300,000 liability insurance. She understands that until a policy is obtained, she must use the affidavit.
Applicant has certificates of completion for 15 hours of health and safety training including CPR and First Aid with expiration date of 7/2025..

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Applicant, Nastassia Marchuk, was reminded that all adults 18 and over living or working in the home, 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.

LPA has provided the Applicant with the web site to enable access to all updated forms, requirements, and changes. Applicant understands that she needs to notify licensing for any modification inside and out of the home. Fire clearance granted on May 14, 2024.

Off-limit areas include: Entire upstairs and Garage. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and Medications are inaccessible to children. The backyard is fenced and there are no bodies of water. There is a swing set in backyard that is anchored to the ground. Applicant understands that 100% supervision is required in any unfenced areas. There is no pool at the home. There are no pets at the home. Stairs are barricaded when children under age 5 years old are present. Planned hours of operation are Monday through Friday, 8:00 am to 11:00 pm and other hours as arranged.
continued on next page.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MARCHUK, NASTASSIA
FACILITY NUMBER: 313625793
VISIT DATE: 06/11/2024
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LPA Owens discussed SB 277 (public health vaccination) and SB 792 (day care facilities: Immunization exemptions) with licensee at time of inspection. LPA observed proof that applicant and staff/ volunteers have met the requirements of SB 792.

LPA observed that applicant has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com.

Proof of AB1207 mandated reporter training is not applicable to as Licensee has limited English proficiency. LPA explained that the OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep web page 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.

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: http://www.ada.gov/childqanda.htm



The applicant provided proof of control of property. Because the applicant 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. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regard to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov. continued on next page.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MARCHUK, NASTASSIA
FACILITY NUMBER: 313625793
VISIT DATE: 06/11/2024
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LPA 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.

On this date, 5/6/2024, 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.

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.

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

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.

Effective today 6/11/2024 applicant is a license to serve up to 14 children, (WHEN THERE IS AN ASSISTANT PRESENT), 12 children -No more than 4 infants. Capacity 14 - No more than 3 infants. 1 Child in Kindergarten or Elementary school and 1 child at least age 6.



Exit interview conducted and report was reviewed with the applicant, Nastassia Marchuk.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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