<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004225
Report Date: 09/17/2024
Date Signed: 09/17/2024 12:55:29 PM

Document Has Been Signed on 09/17/2024 12:55 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:IVANCHYKAVA, ALINAFACILITY NUMBER:
414004225
ADMINISTRATOR/
DIRECTOR:		IVANCHYKAVA, ALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 730-9214
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
09/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:53 AM
MET WITH:Alina IvanchykavaTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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 September 17, 2024, at approximately 11:00am, Licensing Program Analysts (LPAs) Maria Olguin-Leon and Melissa Zaragoza conducted an unannounced annual inspection and met with licensee Alina Ivanchykava, and purpose of inspection was explained. Present during today’s visit was Licensee, two helpers and 10 children (1 infant & 9 preschoolers). Facility is operating within capacity and ratio requirements on this day. All adults present today have criminal background clearances. Childcare hours of operation are Monday - Friday from 8:00am to 5:30pm.

LPAs and Licensee toured and inspected the indoor and outdoor of duplex for health and safety hazards. Duplex is a two-level story home. Day Care Areas: Living room, dining room, downstairs bathroom, downstairs bedroom (napping room), and backyard. Off Limits Areas: Kitchen, entire second floor and garage. Isolation area for ill children will be in napping room and away from other children. LPAs observed home to be clean and orderly. Home is well light and has proper ventilation. Chimney is properly barricaded with cubbies and edging of fireplace is lined with a rubber corner protector. LPAs observed electrical outlets are secured with child proof covers and furniture. Off-limits doors have child safety knobs. Kitchen area and staircase are equipped with a child proof gates for inaccessibility to children in care. Cleaning supplies and other potentially harmful items are stored inaccessible to children. There are plenty of age-appropriate toys, books, child size furnishings, learning material, and sleeping mats, LPAs observed sleeping mats to have tight fitting sheet; parents provide sheets and are sent home weekly for laundering or as needed. LPAs observed each child to have their own sleeping mat. LPAs observed backyard to be equipped with age-appropriate toys which include a slide/swing set play structure, ride-on toys, playhouse, and child size furniture all in good condition. There is an umbrella located in backyard to provide shade to children in care. Outdoor patio flooring is a wood deck and tanbark to cushion falls. There are rubber rug mats under swing set. LPAs did not observe any spas, pools, or other bodies of water.

Home is equipped with a working dual carbon monoxide/smoke detector, and a fully charged fire extinguisher. LPAs reviewed first aid kit and kit is fully stocked. Licensee uses a cell phone on the premise. Per licensee, there are no weapons or firearms in the home. Licensee provides breakfast, lunch and two snacks to children in care. LPAs reminded licensee any food brought from home must be labeled and stored properly.

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: IVANCHYKAVA, ALINA
FACILITY NUMBER: 414004225
VISIT DATE: 09/17/2024
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
26
27
28
29
30
31
32
Page 2...

LPAs reviewed 6 children’s files and 2 staff record. Licensee maintains an updated Children’s roster. Licensee CPR/FA expiration date is 10/2025. Licensee Mandated Reporter has expired. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights posted. Last emergency drill was conducted on 08/01/2024 and properly documented. Emergency drills are conducted monthly. Licensee carries liability insurance via Accord Insurance which ex. 09/2025.

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 Childcare 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/.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA's reviewed AB 1207 with the Licensee.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com

Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: IVANCHYKAVA, ALINA
FACILITY NUMBER: 414004225
VISIT DATE: 09/17/2024
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
26
27
28
29
30
31
32
Page 3...

LPAs 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-and-resources/safe-sleep as an additional resource. LPAs also informed licensees 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.

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

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

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



No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Alina Ivanchykava.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5