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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700366
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:18:22 PM

Document Has Been Signed on 11/08/2023 12:18 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:DZHYLIALOVA, NIIARAFACILITY NUMBER:
435700366
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
11/08/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Niiara DzhylialovaTIME COMPLETED:
12:25 PM
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On 11/08/2023 Licensing Program Analyst (LPA) Melanie Otsuji arrived unannounced to conduct a REQUIRED - 3 YEAR inspection AND CAPACITY INCREASE. LPA met with Licensee Niiara Dzhylialova. Also present were 2 fingerprint cleared staff members and 6 children (1 infant and 5 preschoolers). Hours of operation are 8am - 6pm Monday through Friday. Home was toured for a health and safety inspection.

ON LIMITS AREA: Living Room, Dining Area, Downstairs Bedroom (napping room), downstairs bathroom and backyard


OFF LIMITS AREA: Entire 2nd Floor and Kitchen

The facility is a two-story home. The inside and outside of the home are observed to be neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. The home has a fully charged 3A10BC fire extinguisher on the wall in the entry way closet. There are multiple working smoke detectors in the home. The working carbon monoxide detector is located in the kitchen.

An fire clearance inspection was approved on 11/3/2023 by Palo Alto Fire Department.
The Licensee’s Health and Safety training with lead poisoning component has been completed. Pediatric CPR & First Aid training has been completed and expires 1/22/2024. Licensee’s Mandated Reporter is complete and expires 2/9/2024. All required forms are posted and visible for public view in the entry way. LPA obtained the children’s files and the facility roster. LPA obtained the fire/disaster drill log. Log is complete with last drill logged 9/14/2023.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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: DZHYLIALOVA, NIIARA
FACILITY NUMBER: 435700366
VISIT DATE: 11/08/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Licensee 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 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.

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.

A notice of site visit was given and must remain posted for 30 days. This facility is approved for a large family day care home effective today's date, 11/8/2023. Exit interview conducted and report was reviewed with Niiara Dzhylialova.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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