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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622925
Report Date: 06/13/2024
Date Signed: 06/13/2024 11:10:11 AM

Document Has Been Signed on 06/13/2024 11:10 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:MARTYNOV, TATYANA AND LOBKOV, YEKATERINAFACILITY NUMBER:
343622925
ADMINISTRATOR/
DIRECTOR:		MARTYNOV, TATYANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 223-3697
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
06/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Tatyana MartynovTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On Thursday June 13, 2024, Licensing Program Analyst (LPA) Stephanie Piring met with Licensee, Tatyana Martynov, for an unannounced annual / one year inspection. During the inspection there was a census of three children in care being supervised by the licensee. Co-Licensee Yekaterina Lobkov was present via video call. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 06:00 AM to 06:00 PM.

A health and safety inspection was conducted in the areas accessible to children. The off-limits areas include: right side bedrooms, laundry room, backyard, and 2 storage sheds. Licensees understands that children may never enter off-limits areas. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher within the home. LPA observed home was safe, orderly, and free of hazards. LPA observed fireplace within the home is properly barricaded to meet regulations. Licensee stated there are no firearms on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock.

LPA observed a body of water accessible to children in care. Licensee has an above ground pool in the backyard approximately 4 feet deep filled with water, surrounded by a 5 foot fence that does not allow view of the pool. The gate is also not self latching. The fence is not in compliance with Title 22 regulations and allows access to the pool from the home windows.

LPA observed all required postings, a children's roster and fire drill log, the last fire drill was conducted 05/2024. LPA reviewed records of children’s files and staff files. Licensee 1 has current EMSA approved pediatric CPR/First Aid training, which expires 07/2025. Licensee does not have current Mandated Reporter Training, it recently expired 4/2024. Licensees understands both CPR and mandated reporter training's’ must be completed every two years.

Continued on LIC809-C

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Stephanie Piring
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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: MARTYNOV, TATYANA AND LOBKOV, YEKATERINA
FACILITY NUMBER: 343622925
VISIT DATE: 06/13/2024
NARRATIVE
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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.

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 [or facility representative] 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: https://www.ada.gov/resources/child-care-centers/.

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.

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.

Continued on LIC809-C

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Stephanie Piring
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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: MARTYNOV, TATYANA AND LOBKOV, YEKATERINA
FACILITY NUMBER: 343622925
VISIT DATE: 06/13/2024
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Based on Today’s inspection, Title 22 Deficiencies are being cited on 809-D and an immediate civil penalty of $500 is being assessed.

The Licensee was informed that this report dated 06/13/2024 documents one Type A citation which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Licensee has been provided with appeal rights.

This report was reviewed with licensee, and an exit interview was conducted.

A Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Stephanie Piring
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/13/2024 11:10 AM - It Cannot Be Edited


Created By: Stephanie Piring On 06/13/2024 at 10:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MARTYNOV, TATYANA AND LOBKOV, YEKATERINA
FACILITY NUMBER: 343622925

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited abovewhich poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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Licensee will submit plan to make pool inaccessible to LPA by POC due date. Licensee will make the pool inaccessible to children in care within 7 days.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Stephanie Piring
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/13/2024 11:10 AM - It Cannot Be Edited


Created By: Stephanie Piring On 06/13/2024 at 10:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MARTYNOV, TATYANA AND LOBKOV, YEKATERINA
FACILITY NUMBER: 343622925

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2024
Plan of Correction
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Licensees will send proof of complete Mandated Reporter Training for both licensees to LPA Piring by 4pm on POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Stephanie Piring
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
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