343624809-3-7-2023-03-CC-LHAM-CPPPTG-20230307103556

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624809
Report Date: 03/07/2023
Date Signed: 03/07/2023 10:36:04 AM

Document Has Been Signed on 03/07/2023 10:36 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	BURAKOVSKA, LIUDMYLA		FACILITY NUMBER:	343624809
ADMINISTRATOR:	BURAKOVSKA, LIUDMYLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 272-6915
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	03/07/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Liudmyla Burakovska		TIME COMPLETED:	10:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On March 7th, 2023 Licensing Program Analyst (LPA) Lea Habtom conducted a Pre-Licensing inspection with applicant Liudmyla Burakovska. Applicant was the only person present at the time of the inspection. Applicant is applying for a Large Family Child Care License. Applicant was previously a co-licensee at facility number #343623767. A health and safety inspection of the home was conducted. Applicant resides in a studio which consists of a 1 bathroom, kitchen, shared dinning room, living room & bedroom & a fenced backyard. There will be no off-limits areas in the home. Applicant plans to operate Monday through Friday from 8 am- 7pm and as hours as arranged. There is no fireplace or stairs in the home. The home appeared clean and orderly, and toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors and a 2A10BC fire extinguisher were observed in the home. Current pediatric CPR and first aid training was verified and expires 1/2024. Applicant stated there are no weapons in the home. No bodies of water were observed at the home. Applicant has provided proof of Immunization for Pertussis, Measles and Influenza. Tuberculosis clearances for all adults in the home have been provided. Applicant has a waiver for AB1207 Mandated Reporter training due to language barrier. Applicant understands that the training must be completed once every two years, and that Mandated Reporter trainings offered outside of http://childcare.mandatedreporterca.com/ , must be approved by the department. All individuals subject to criminal background review have obtained a criminal record clearance. 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, 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.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BURAKOVSKA, LIUDMYLA	FACILITY NUMBER: 343624809
	VISIT DATE: 03/07/2023

NARRATIVE

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Applicant understands that any adult assistants for the childcare must also obtain the following: EMSA certified CPR and first aid training, immunizations for measles Pertussis and Influenza, complete AB1207 Mandated Reporter Training, and complete eight hours of preventative health and safety training.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Applicant was encouraged to always maintain supervision. LPA advised applicant that 100% supervision is required in areas outside of the home that are unfenced.

LPA explained to applicant that if they move and want to continue to provide care, they must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.

Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area.

LPA reviewed and provided the prelicensing packet to 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. Applicant understands that children’s records are to be maintained and be accessible to licensing for up to three years after the child is no longer enrolled. Applicant provided/ did not provide landlord consent form and understands that care can only be provided for up to 6 children unless landlord consent granted. LPA discussed the necessity for applicant to obtain and record children’s immunizations on form PM 286. Applicant understand that is she does not attain a $300,000 liability insurance policy, form LIC 282 must be provided to parents.

LPA discussed capacity and ratios with applicant.

LPA informed applicant that all inspections after today will be unannounced.

Immediate Civil Penalties were discussed.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BURAKOVSKA, LIUDMYLA	FACILITY NUMBER: 343624809
	VISIT DATE: 03/07/2023

NARRATIVE

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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage 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. Licensee does not have pack n plays or cribs at the time of inspection and states if she accepts infants she will purchase them.

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

This facility evaluation report was reviewed and discussed with the applicant.

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.

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.

Exit interview conducted and report was reviewed with the applicant

Effective today, March 7, 2023, applicant is approved for a Large Family Child Care License. Applicant can provide care for 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in transitional kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years. Licensee understands that when there is no assistant present, ratios of a small capacity must be adhered to.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC809 (FAS) - (06/04)

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