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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101360
Report Date: 07/19/2024
Date Signed: 07/19/2024 04:08:25 PM

Document Has Been Signed on 07/19/2024 04:08 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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BLUM, DANIEL & KOPMAN, POLINA FCCFACILITY NUMBER:
376101360
ADMINISTRATOR/
DIRECTOR:		DANIEL B. & POLINA K.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 331-9908
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
07/19/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Polina KopmanTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On July 19, 2024, at 2:30 PM., Licensing Program Analysts (LPAs) Sherlynn Banas and Adriana Macias conducted an unannounced case management inspection in reference to the licensee’s request to make a change to an off-limits area in the daycare floor plan. Upon arrival LPAs met with Licensee, Polina Kopman and proceeded to tour the facility inside and outside per facility sketch. There were 9 children in care and 1 infant who is her own child. Also present was the licensee’s helper. Adilene Wadeea. The facility was observed operating within ratio and capacity.

The carbon monoxide, smoke alarm and fire extinguisher were all operational. The kitchen and the garage, and all the second floor are off-limits. The second floor was barricaded by a wooden safety gate. The licensee states that bedroom downstairs will be used for nap only. The nap room will be used as an extra activity room during the rainy season. All poisons, cleaners and hazardous items in the room are inaccessible to children through latches, locks, and/or placed up on high surfaces. An updated facility sketches reflecting living room as an inaccessible room has been submitted and off-limits for children in care.

The CPR/FA for Polina Kopman and Daniel Blum expires on December 3, 2024. Mandated Reporter for Polina Kopman expires on 2/13/2025. Daniel Blum Mandated Reporter certificate expires on 2/14/2025. The hours of operation are from 8:00 AM. to 5:30 PM.

No deficiencies are cited.

Exit interview was conducted. LPAs provided notice of site visit and observed being posted.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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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