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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314033
Report Date: 07/05/2023
Date Signed: 07/05/2023 12:33:11 PM

Document Has Been Signed on 07/05/2023 12:33 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SLUCHENKOV, VLADISLAVFACILITY NUMBER:
304314033
ADMINISTRATOR:SLUCHENKOV, VLADISLAVFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 705-8163
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY: 12TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
07/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Elena Maslenkina, AsstTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAS) P Rivas and V Trinh conducted an unannounced annual inspection.
LPAs were allowed entrance by staff Elena Maslenkina who had 3 children in care. LPA was advised by Ms. Elena that Naynara Tangeland was off today. LPA had staff call and text licensee. At 8:48 am Ms. Prisyazhnyuk arrived. Ms. Prisyazhnyuk stated she was here to assist child #6 since it was their first day at the facility but she can also assist me for 2 hours since she can not be gone from her facility for more than two hours Ms.Prisyazhnyuk questioned why LPA was here since LPA had been here 2 weeks ago and spent 5 hours. LPA advised her that she was here to conduct annual inspection and LPA did not review all records on prior visit. LPA also advised Ms. Prisyazhnuk that LPA spent 5 hours because LPA was providing licensee time to provide copies of files to Asst and also Asst had to provide care and supervision throughout inspection so inspection was interrupted. LPA asked Ms. Prisyazhnyuk to please contact licensee, who she stated was in Montana. Ms. Prisyazhnuk stated licensee was in Montanan from 06/05/23 and is due to return 07/27/23.
LPA advised Ms. Prisyazhnuk cursory review of files did not find lic9224. Ms. Prisyazhnuk indicated that licensee was appealing decision. LPA told Ms. Prisyazhnuk that she had told Asst. Tangeland the plans of corrections had to be completed including forms in files. LPA also advised that LPA emailed licensee on 06/22/23 and advised him even if he was going to appeal all plans of corrections had to be completed. Ms. Prisyazhnuk left at 9:25 am to her facility in order to make copies of roster and copies of child #6s file as she has not access here. At 8:49 am LPA asked Ms. Prisyazhnuk if all the files provided were complete and she stated yes. Through out visit children continue to arrive. by 9:31 am there were 11 children present and only assistant was present.
LPA was advised hours of operation are from 8:30 am to 5:00pm Monday to Friday
.A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee states she is the only adult living in the facility. Licensee also stated there are no children under the age of 18 living in the home
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2023
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SLUCHENKOV, VLADISLAV
FACILITY NUMBER: 304314033
VISIT DATE: 07/05/2023
NARRATIVE
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staff 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.

During today’s inspection, LPA and assistant toured the inside and outside areas identified in the facility sketch as accessible to childcare children. The following was observed and reviewed during this inspection. This is a two-story home which consists of 3 bedrooms and 2 bathrooms. The rooms utilized for the day care are the living room, dining room, kitchen, back yard, and downstairs bathroom. Upstairs is off limits. However, during today's inspection the gate leading to the second floor was not in place. LPAs and Ms. Yulia toured upstairs no deficiencies noted. The children use the backyard of the home for outdoor play time. There are no bodies of water on the premises. The backyard was observed to be fenced with age appropriate toys and free of hazards. The Licensee was reminded that full supervision is required at all times to ensure children do not have access to the off-limit areas. The off-limit areas are will be kept closed during day care hours.

There are working carbon monoxide, smoke detector, in the home that meet statutory
Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily
available to children were stored inaccessible to children. Staff stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections. The facility has age appropriate toys for the ages served. LPA verified there is a working cellular service , staff number 562 613-9777.The licensee does have a current roster of children in care.
The licensee's Pediatric CPR/First Aid certification is current. . Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles, licensee declined flu shot. for licensee were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. Licensee did not complete Mandated reporting training, citation issued.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SLUCHENKOV, VLADISLAV
FACILITY NUMBER: 304314033
VISIT DATE: 07/05/2023
NARRATIVE
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Staff stated incidental medical services is not provided.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child Care Homes 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
The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.CCLD website www.cdss.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to

register through [email protected] in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. “A Child Care Providers Guide to Safe Sleep” was discussed to the licensee. The following electronic links were also provided: English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative


Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
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

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SLUCHENKOV, VLADISLAV
FACILITY NUMBER: 304314033
VISIT DATE: 07/05/2023
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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.

In the areas that were evaluated, The following deficiencies were observed of the Health and Safety Code Section 1596.8595 (c)

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 [email protected]. 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/inspection-process.

An exit interview was conducted with assistant Elena Maslenkina Appeal Rights were explained. The licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/05/2023 12:33 PM - It Cannot Be Edited


Created By: Pat Rivas On 07/05/2023 at 11:55 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SLUCHENKOV, VLADISLAV
FACILITY NUMBER: 304314033

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1595.8595(c)
Health and Safety Code Section 1596.8595 (c) A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review 12 out of 12 children files did not contain lic 9224 or an ascknowledgement and based on telephonic interview with llicensee who stated he did not think he had to provide report because he was going to appeal citation, the licensee did not comply with the section cited above in out of 12 out of 12 children files. This is a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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licensee designeee Ms. Maslenkina stated she will provide copy of report to each parent and have them sign lic 9224 to put in the child's file by plan of correction and to provide copy to LPA by plan of correction date (even if an appeal is going to be made)
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2023


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