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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101360
Report Date: 02/12/2024
Date Signed: 02/12/2024 01:58:19 PM

Document Has Been Signed on 02/12/2024 01:58 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BLUM, DANIEL & KOPMAN, POLINA FCCFACILITY NUMBER:
376101360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/12/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Daniel Blum and Polina KopmanTIME COMPLETED:
02:10 PM
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On 02/12/2024 at 11:55am, Licensing Program Analysts (LPAs) Selina Siao and Renita Rodriguez conducted an unannounced random inspection and a capacity increase inspection. Upon arrival Daniel Blum was reparking his car outside as LPAs was at the front door and co-Licensee Polina Kopman with their newborn daughter in the kitchen while she was preparing lunch for the day care children. Helper Michelle Ruh was supervising the five-day care children in the fenced backyard. The home was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 2A10BC located in the laundry room, smoke and carbon monoxide detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee stated that there is no weapon in the home. There is a spa located in the fenced backyard that has a cover and it's locked and inaccessible to children. A review of staff records on this date indicates that helper/substitute teacher Michelle Ruh is not associated to the facility. Both licensee’s First Aid and CPR certifications are valid through 12/03/2024. Both licensees have the required measles and Tdap immunization. Licensee Polina Kopman completed the online mandated child abuse training on 02/13/23 and co-licensee Daniel Blum completed the online mandated child abuse training on 2/14/2023. Licensees was reminded that the training must be renew every two years. Children’s records were reviewed. Facility has an updated roster and fire drill log available for review. Licensee last conducted a drill with the children in care on 01/30/2024. A copy of the facility roster was obtained during today’s inspection.

Licensees has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include living & dining room (Kids Area), bedroom for napping and bathroom. Off limits areas include kitchen, family room, laundry room and upstairs and the area inaccessible through use of safety gates. The facility has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2024
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: BLUM, DANIEL & KOPMAN, POLINA FCC
FACILITY NUMBER: 376101360
VISIT DATE: 02/12/2024
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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: https://www.ada.gov/resources/child-care-centers/.

The following items were discussed with provider: Licensees was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

LPA discussed the safe sleep regulations with both licensees and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs also informed licensees 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.

Licensees was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe. LPA discussed California Megan's Law with provider and advised her to go on the website at www.meganslaw.ca.gov.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: BLUM, DANIEL & KOPMAN, POLINA FCC
FACILITY NUMBER: 376101360
VISIT DATE: 02/12/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensees was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During the exit interview, Both licensees , confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC809D for deficiency cited.

A fire clearance for a large license was granted by the San Diego fire department on 1/24/2024. A large license will be granted effective 2/14/2024.

Exit interview conducted and report was reviewed with both licensee.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/12/2024 01:58 PM - It Cannot Be Edited


Created By: Selina Siao On 02/12/2024 at 01:30 PM
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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BLUM, DANIEL & KOPMAN, POLINA FCC
FACILITY NUMBER: 376101360

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as helper Michelle Ruh was caring for the children and has the required background clearances but she is not associated to the facility. Which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/13/2024
Plan of Correction
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Licensee Daniel Blum associated helper Michelle Ruh during today's inspection and both licensee understands that all adult needs to be associated to the facility prior to helping or living in the home.
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:Tashima Daniel
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2024


LIC809 (FAS) - (06/04)
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