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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005161
Report Date: 09/26/2024
Date Signed: 09/26/2024 01:20:17 PM

Document Has Been Signed on 09/26/2024 01:20 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:DONTOVA, NATALIAFACILITY NUMBER:
414005161
ADMINISTRATOR/
DIRECTOR:		DONTOVA, NATALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 802-9778
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Applicant, Natalia DontovaTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On September 26, 2024, at approximately 9:00am, Licensing Program Analyst (LPAs) Melissa Zaragoza and Maria Olguin Leon conducted a scheduled, pre-licensing inspection. LPAs met with applicant, Natalia Dontova and explained the purpose of the inspection. Applicant applied for a large family childcare license. Present during LPAs visit included applicant only.

Applicant applied for a family childcare home on September 13, 2024. Applicant plans to operate Monday through Friday 8:00am to 5:30pm. Applicant plans to care for children ages 1 years old to school age. Applicant is aware children living in the home under 10 years old, are counted towards overall capacity. Per applicant, applicant is the only person living in the home. All adults living in the home have fingerprint clearance on file.

With applicant, LPAs inspected the entire home, inside and outside, for health and safety hazards. The home is a one level home that consists of 3 bedrooms and 2 bathrooms.

The DAY CARE AREAS the living room, bedroom #2 (napping room), bedroom #3, bathroom #2, and the backyard. The OFF LIMIT AREAS are the kitchen, dining room, bedroom #1, bathroom #1, “classroom” (studio/room in the backyard), and garage. Off limit areas are made inaccessible with child safety door handles and installed child safety gates.

LPAs observed the day care area to be clean and safe. Home is equipped with a fully charged fire extinguisher that is located in the closet. Home is equipped with multiple smoke and carbon monoxide detectors. During visit, LPAs tested smoke and carbon monoxide detector that were observed to be working.

Day care areas were observed to be equipped with a variety of toys, materials and furniture that were age appropriate. LPAs observed electrical outlets to be made inaccessible with safety covers.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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 4
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: DONTOVA, NATALIA
FACILITY NUMBER: 414005161
VISIT DATE: 09/26/2024
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Although kitchen is off limits, kitchen was observed to have two child safety gate installed. Knives and sharp objects are made inaccessible in the homes off limit area. Bathroom #2 was observed to be in proper working condition. LPAs observed drawers and cabinets to be empty. Bathroom #2 is equipped with age-appropriate toileting equipment and sanitation products.

Outdoor backyard was observed to be fully fenced and fake grass flooring. "Classroom" (studio/room) is located in the backyard. LPAs observed room to be empty. Per applicant, room will not be used. LPAs did not observe any pools, spas or bodies of water on site. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care. LPAs reminded applicant emergency disaster drills are to be conducted and documented at least once every six months.

Applicant's discipline policy will be to redirect child with social emotion learning, by reading books, and using puppets. Applicant will also communicate with children's families regarding behavior. The designated isolation area will be in bedroom # 3. LPAs reminded applicant; children must be supervised at all times. Applicant plans to provide a food service that includes breakfast, lunch, dinner, morning snacks, and afternoon snack. Food preparation, sanitization, children's allergies was discussed. LPA also reminded the applicant about labeling food that is brought from home, including baby bottles, and lunch bags.

Applicant's CPR/First Aid training is current and will expire October 2025. Applicant's Mandated Reporter training certification is also current and will expire on 09/24/2026. LPAs reminded applicant CPR/First Aid training and Mandated Reporter training must be renewed every two years. Applicant were also reminded Mandated Reporter training must be renewed every two years by all staff working with children. Applicant has proof of required immunizations (MMR, Tdap and Tb) that were provided to LPAs. Per applicant, there are no weapons or firearms in the home.

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.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: DONTOVA, NATALIA
FACILITY NUMBER: 414005161
VISIT DATE: 09/26/2024
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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).

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.

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. Entrance checklist was provided to the applicant.

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-andresources/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.

On this date, 09/13/2024, 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.
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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: DONTOVA, NATALIA
FACILITY NUMBER: 414005161
VISIT DATE: 09/26/2024
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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.

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.

Prior to recommended licensure, the following must be completed:
-Management approval
-Heater covers
- In addition, for large capacity approval the pending documents are, 1 year experience working in a childcare center and Fire Clearance.


Exit interview conducted and report was reviewed with the applicant, Natalia Dontova
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4