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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700321
Report Date: 08/05/2022
Date Signed: 08/05/2022 01:50:06 PM

Document Has Been Signed on 08/05/2022 01:50 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MISHYNA, HULIZARFACILITY NUMBER:
435700321
ADMINISTRATOR:MISHYNA, HULIZARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 937-4543
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Hulizar MishynaTIME COMPLETED:
02:00 PM
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On 08/5/2022 at approximately 12:26pm, Licensing Program Analyst (LPA) Sabina Dodoo met with licensee Hulizar Mishyna for an UNANNOUNCED ANNUAL REQUIRED INSPECTION for a Large Family Child Care Home. Present for the inspection were the Licensee and two aides who are all fingerprint cleared. The total children enrolled are 14 and the census was 6 children at the time of the inspection. The Family Child Care Home is within ratio. The Family Child Care Home was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 8am to 6pm.

PHYSICAL PLANT: The Family Child Care Home is a single-story residential home with 3 bedrooms, and 2 and half bathrooms. The entrance of the Family Child Care Home is the main door of the home. The living room has been converted into an activity room. There are two rooms for napping with napping beds. LPA observed children eating lunch and drinking water. LPA observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). All hazardous materials and toxins are kept out of reach from children and are not accessible. This Family Child Care Home has one fully charged fire extinguisher 3A-10- 40 BC, multiple dual smoke and carbon smoke detectors, a telephone and a fully stocked first aid kits. The furniture around the activity area and outdoor area are all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children.

On Limit Areas are: the 2 bedrooms for napping, the half bathroom in the hallway, the living room(activity room) and the entire backyard.

Off Limit Areas are: dining room, the kitchen, the garage, the master bedroom and master bathroom.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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: 08/05/2022
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FOOD & SNACK: The licensee provides breakfast, lunch, dinner, AM snack and PM snack. Licensee provides water and milk.

OUTDOOR: LPA Dodoo observed the outdoor play area which has a play structures with slides and play houses. There is a soft cushioning material around the play structure to absorb falls. The outdoor play area is also fenced all around with secured gates.

RECORDS: LPA Dodoo reviewed 3 children’s files and 3 staff files and documented them on LIC 857 and LIC 859. A current roster was viewed by LPA. LPA obtained a copy from Licensee. The staff interview was completed with Licensee Hulizar Mishyna. Licensee has completed the Health and Safety training and CPR/First Aid is current. Licensee is following the immunization laws and has completed the mandated reporter training. The Licensee has conducted and documented the fire and disaster drills twice a year and the last conducted drill was on February 27th, 2022. All required forms are posted and visible for public view.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children in care currently. If 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: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
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: 08/05/2022
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Licensee was reminded that all adults 18 and over working in Child Care Center, 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 Child Care Center. 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 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. 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 reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There are no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Licensee (Hulizar Mishyna). This report shall remain on file for the next 3 years.

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

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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