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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625888
Report Date: 07/24/2024
Date Signed: 08/13/2024 09:05:35 AM

Document Has Been Signed on 08/13/2024 09:05 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:SHESTAKOVA, VIKTORIIAFACILITY NUMBER:
343625888
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
07/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Viktoriia ShestakovaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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THIS IS AN AMENDED REPORT DUE TO ERROR WITH THE TYPE OF VISIT. ORIGINAL REPORT CREATED 7/23/24.

On Wednesday, July 24, 2024 at 10:30 AM, Licensing Program Analyst (LPA) Tanya Washington arrived at the facility and met with applicant Viktoriia Shestakova, for the purpose of a pre-licensing inspection. The inspection was conducted in Russian language. There were no daycare children present during today's inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant stated she plans to operate Monday- Friday from 8:00 AM to 7 PM.

Applicant rents this home and copy of the rental agreement was provided with the application. Because the applicant rents the home, proof of landlord notification is required. Applicant submitted signed form LIC9151 confirming that the landlord was verbally informed that childcare will be provided. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

A health and safety inspection were conducted inside and out. This facility is a single story home with three bedrooms, two bathrooms, kitchen, living room, laundry room, garage and fenced backyard. Off limit areas of the facility will consist of master bedroom/ bathroom, laundry room and garage. Off-limit areas will remain inaccessible to children by closed door and/or supervision. Toxic and hazardous items are inaccessible to children. LPA observed a functioning dual smoke and carbon monoxide detector. LPA observed a charged 2A10BC fire extinguisher. Preventative Health, current pediatric CPR and first aid training was verified and expires 04/2026. Applicant is exempt from Mandated Reporter Training due to language barrier. Applicant stated that there are no weapons in the home. LPA explained the requirement of documenting fire drills at least once every six months.

Report continued on LIC809C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: SHESTAKOVA, VIKTORIIA
FACILITY NUMBER: 343625888
VISIT DATE: 07/24/2024
NARRATIVE
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Fireplace located in the living room is properly barricaded. Applicant understands that children must be 100% supervised around bodies of water. Immediate Civil Penalty regulation and deficiencies were reviewed. There are no bodies of water on the premises.

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, 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 reviewed with applicant and provided copies of all forms required for children's records including form LIC311D, Forms/Records To Keep In Your Family Child Care Homes, and information to be posted.

LPA consulted applicant regarding the following topics; Type A vs. Type B deficiencies, complaints, LPA right to interview children without parental consent, civil penalties, incidental medical services, placement of detergents, placement of poisons, placement of medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, On-limits vs. Off-limit areas, licensing file management, 80% supervision, 100% supervision, fingerprint clearances, advertising, mandated reporting best practices, and applicant’s responsibility to stay up to date on new law and regulations.

LPA consulted the applicant regarding personal rights. Applicant understands that corporal, physical and/or unusual forms of punishment is never allowed toward day care children or their own children during day care hours.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the Applicant can obtain updated licensing information, new regulations and access forms. LPA advised Applicant of their responsibility to stay current regarding new regulations.
LPA advised applicant to sign up for the quarterly updates provided by the Childcare Advocates Program.

Report Continued on LIC809C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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: SHESTAKOVA, VIKTORIIA
FACILITY NUMBER: 343625888
VISIT DATE: 07/24/2024
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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.

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) or (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.

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.

Applicant was informed of the MyChildCarePlan.org site, 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.

Effective today, 07/24/2024 this facility is granted a small license for a MAX CAPACITY- of 6 children no more than three infants or four infants only. Applicant understands that related children under 10 years old count in ratio and capacity when present in the home.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
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