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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409219
Report Date: 03/16/2022
Date Signed: 03/16/2022 10:04:25 AM

Document Has Been Signed on 03/16/2022 10:04 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:STEFANETS, NATALIIAFACILITY NUMBER:
073409219
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/16/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nataliia StefanetsTIME COMPLETED:
10:25 AM
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On 03/16/2022 at 9:00 AM Licensing Program Analyst (LPA), Melissa Guirit conducted an announced Prelicensing inspection. LPA met with applicant, Nataliia Stefanets who submitted an application for a small Family Child Care Home. Also present was the applicant’s minor child. The hours of operation for the family child care home will be Monday-Friday 7:30am-6:00pm. A tour of the home was completed with the applicant to conduct a health and safety inspection.

The home is two story and consist of four bedrooms, three bathrooms, living room, kitchen, dining area, laundry room, garage, playroom, and backyard. The children will use the downstairs bathroom, play room to the right of the entry way, downstairs bedroom, and backyard. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. The off-limits areas are the entire second level, kitchen, living room, dining area, laundry room, and garage which will be inaccessible by closed and/or locked doors, safety gates, and visual supervision. Per applicant, the living room will only be used to walk through to go to the back yard. The Isolation area for ill children will be in the downstairs bedroom. The back yard will be used as the outdoor play area and is fully fenced. The applicant was advised that any area that will be changed to an on limit area will need to be inspected by Licensing prior to use. There were safe toys, play equipment, and materials observed for children. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The applicant was advised that all poisons and/or hazardous items must be kept in a locked cabinet/drawer or placed out of reach of children. The applicant stated there are no firearms on the premises.



The home is equipped with a fully charged 3A40BC fire extinguisher, working smoke alarm, working carbon monoxide detector, telephone, and first aid supplies. The applicant completed the required preventative health and safety training, which includes 1 hour of nutrition, the required lead poisoning prevention training, and has current CPR and First Aid training which expires on August 9, 2022. Applicant has completed the Mandated Reporter Training which shall be renewed on 10/25/2022.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: STEFANETS, NATALIIA
FACILITY NUMBER: 073409219
VISIT DATE: 03/16/2022
NARRATIVE
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LPA reviewed with licensee 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. LPA advised the applicant that the postings need to be in a place that is visible and accessible to the public. LPA reviewed the ratio and capacity of a small family child care home license. 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 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.

The applicant is reminded of the following: to review and follow COVID-19 guidelines, to report any injuries or unusual incidents, including COVID-19 exposures and positive results at the facility. The applicant is advised to review licensing regulations and guidelines, including the Provider Information Notices (PINs) on the website www.ccld.ca.gov and to sign up to receive quarterly updates by email by sending a request to [email protected].

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: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: STEFANETS, NATALIIA
FACILITY NUMBER: 073409219
VISIT DATE: 03/16/2022
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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, 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 verified that the applicant has a criminal record clearance and is associated to the license. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com.

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 platform.

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.


This home will be licensed effective today, 03/16/2022. An exit interview was conducted with Nataliia Stefanets and a copy of report provided.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
LIC809 (FAS) - (06/04)
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