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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700321
Report Date: 02/18/2022
Date Signed: 02/18/2022 11:24:05 AM

Document Has Been Signed on 02/18/2022 11:24 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MISHYNA, HULIZARFACILITY NUMBER:
435700321
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mishyna, HulizarTIME COMPLETED:
11:30 AM
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On Friday 2/18/2022 at approximately 9:30am Licensing Program Analyst (LPA) Sabina Dodoo and Licensing Program Manager (LPM) Chandra Charles, met with Licensee Hulizar Mishyna to conduct an unannounced Case Management Inspection for Change in Capacity. At the time of the inspection Licensee Hulizar Mishyna was present with two aides (Karine Haruthyunyan, Tatsiana Hancharyk) and her husband (Oleksandr Mishyn)who are all fingerprint cleared. The census at the time of visit is 6 children.

The home is a single-family residential house with an attached garage. LPA Dodoo, LPM Charles and the licensee toured the home inside and outside for a health and safety inspection. The home consists of a living room, one master bedroom with a master bathroom, one kitchen, two hallway bathrooms and two additional bedrooms. There is a fireplace located in the living room that is covered. There is a backyard that can be accessed through a gate by the patio area. The home is equipped with working carbon monoxide detector, smoke detectors and one fully charged 2A-10-BC fire extinguisher. The home has heating and ventilation for safety and comfort. Per the Licensee there are no firearms in the home. Licensee has a current copy of a lease which shows Hulizar Mishyna has control of the property.

CPR/ First Aide is current from 5/27/2021 to 5/27/2023. After a review of the file the applicant has completed the Mandated Reporter Training which will expire on 12/30/2023. Licensee is adhering to the immunization laws as it is required for all day care providers. Licensee has requested for a change in facility capacity from a small (8) to a large (14). A fire clearance was granted by the Palo Alto Fire Department with a condition that the garage will be off limits

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MISHYNA, HULIZAR
FACILITY NUMBER: 435700321
VISIT DATE: 02/18/2022
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Clarification and correction were made with licensee on what rooms and areas are on limits for Day Care Children: living room, 2 additional bedrooms, bathroom 1 and the backyard behind the house. 2 additional bedrooms are converted into napping rooms with 6 tiny beds per room and one crib for children.

The Off-Limit Areas: the kitchen, master bedroom with master bathroom, the first patio area with covered jacuzzi, and the first hallway bathroom located near the living room.

The patio area is off limits but on limits only for children to walk through to go to the backyard.

Upon inspection of the home LPA Dodoo concluded that Licensee is complying today. There are no bodies of water on the premises. Licensee has a non-operable jacuzzi that is empty and fully covered located just outside the kitchen door, leading to the patio.

Licensee Hulizar Mishyna, was reminded that all adults 18 and over living or working in the home, 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

LPA Sabina Dodoo, discussed the safe sleep regulations with licensee Hulizar Mishyna, 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 licensee 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 was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to emailchildcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

During the inspection no files were reviewed. Exit interview conducted and report was reviewed with the licensee Hulizar Mishyna. A copy of this report and notice of site visit was given to Licensee. This report shall remain on file for three years.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC809 (FAS) - (06/04)
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