380505340-4-19-2024-05-CC-BVAN-D4H2JT-20240419172651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505340
Report Date: 04/19/2024
Date Signed: 04/19/2024 05:27:00 PM

Document Has Been Signed on 04/19/2024 05:27 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 BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SERGUNINA, TATIANA & ABAZYAN, VERGINE		FACILITY NUMBER:	380505340
ADMINISTRATOR/ DIRECTOR:	SERGUNINA,T & ABAZYAN, V		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 664-0921
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 7	DATE:	04/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:30 PM
MET WITH:	Vergine Abazyan		TIME VISIT/ INSPECTION COMPLETED:	05:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 19, 2024., Licensing Program Analyst (LPA) Van conducted a required inspection and met the Licensee, Vergine Abazyan. Per Ms. Abazyan, her co-licensee, Tatiana Sergunina, was on a few day's vacation. LPA explained the purpose of the inspection to the Licensee and was given access to the home. The licensee and her helper supervised 7 children (four infants and three preschoolers). During the inspection, another helper, Anastasiia Moskaliuk, arrived to assist with paperwork. The Licensee complies with the licensing capacity and limits today. All adults present during the inspection have cleared criminal clearance verified with the CDSS Guardian site. There are no changes to the childcare areas previously approved, with the same off-limits and childcare areas. The childcare area is the entire ground floor, including the kitchen, playroom, nap room, bathroom, and backyard. Off-limit areas are the entire upstairs and garage. All off-limit areas are appropriately barricaded. The days and hours of the operation are Monday – Friday from 8:00 am – 5:00 pm. The Licensee has valid childcare liability insurance on file. LPA and the Licensee inspected the childcare areas for any potential dangers to health and safety hazards. LPA observed that the childcare areas were clean and in good condition. There were age-appropriate toys such as imaginative, creative, and manipulative play. The home has appropriate heating, lighting, and ventilation, and no potential hazards could endanger children in care. No fireplace was observed in the childcare areas. The Licensee had a fully charged fire extinguisher with the specification of 3A 40 BC and a carbon monoxide and smoke detector. A functional phone was also available in case of emergencies. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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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Document Has Been Signed on 04/19/2024 05:27 PM - It Cannot Be Edited

Created By: Brendon Van On 04/19/2024 at 04:37 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SERGUNINA, TATIANA & ABAZYAN, VERGINE	FACILITY NUMBER: 380505340
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)(3)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the Licensee had seven playpens, five of which children were napping in. LPA noticed that all five playpens had wool blankets used as bedsheets. The blankets were observed dislodged and loosely, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/03/2024
	Plan of Correction
1 2 3 4	The Licensee must ensure and adhere to the infant's safe sleep regulation by keeping loose objects, such as blankets, pillows, and toys, out of the infant cribs/play yards during napping. The licensee states that she will purchase fitted bedsheets and replace them all over the weekends. A return visit is required to ensure the deficiency has been corrected.

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. She did not document the infant's sleep logs properly and consistently. The licensee did not indicate the dates the check was made, which poses a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 05/03/2024
	Plan of Correction
1 2 3 4	The licensee must ensure that the 15-minute check is documented with an initial. Moving forward, the license agrees to document the sleep checks for all infants under 24 months, and all checks must be dated. . A return visit is required to ensure the deficiency has been corrected.

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Brendon Van

LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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 BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SERGUNINA, TATIANA & ABAZYAN, VERGINE	FACILITY NUMBER: 380505340
	VISIT DATE: 04/19/2024

NARRATIVE

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LPA reminded the Licensee that cleaning agents and detergents must be safely stored out of children's reach, as LPA found cleaning products stored under the kitchen cabinet without child-proof locks/latches installed. The licensee confirmed that no firearms or weapons were present on the premises. LPA did not observe baby walkers, bouncers, or similar equipment in the childcare areas, and the Licensee was reminded that smoking is prohibited in the family childcare home.

The backyard was fenced entirely with age-appropriate playthings and was free from any hazards or debris that could pose a risk to the children in care.

During the inspection, LPA observed that the Licensee had seven playpens, five of which children were napping in. LPA noticed that all five playpens had wool blankets used as bedsheets. The blankets were observed dislodged and loosely, potentially posing a hazard to sleeping infants. LPA reminded the Licensee that cribs or playpens must be completely free of toys, blankets, or pillows. The padding and mattress used in the playpen must be designed to fit its dimensions, and a bed sheet must be securely fitted. Furthermore, the Licensee must ensure infant safety with 15-minute napping checks, which must be documented consistently with the check dates and available for review.

The licensee and helpers have maintained complete records and have met all the necessary licensing requirements, including completing required immunizations, mandated reporter training, and maintaining a valid Pediatric CPR/First Aid certification. All the required posting documentation, such as the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist, have been placed in a prominent area for parents or representatives to review. According to the licensee, regular fire and earthquake drills are conducted at least once every six months. The latest drills were completed on 11/20/2023.

The records of all the children who were present were reviewed. The licensee maintains accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. These emergency documents contain information such as the child's full name, phone number, and the location of a parent or authorized person who may be contacted in an emergency. The records also contain the name and phone number of the child's doctor and the parent's permission for the licensee to consent to emergency medical care if needed.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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 BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SERGUNINA, TATIANA & ABAZYAN, VERGINE	FACILITY NUMBER: 380505340
	VISIT DATE: 04/19/2024

NARRATIVE

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During the inspection, LPA reviewed forms/records to keep in your family's child care homes, children's forms/records, and personnel forms/documents with the Licensee. In addition, license capacity and limitations were also reviewed with the licensee.

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 the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.

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: www.ada.gov/childqanda.htm.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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 BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SERGUNINA, TATIANA & ABAZYAN, VERGINE	FACILITY NUMBER: 380505340
	VISIT DATE: 04/19/2024

NARRATIVE

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The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

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

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/process.

See LIC 809D for deficiencies cited today.

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

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report was reviewed with the licensee, Vergine ABAZYAN.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

LIC809 (FAS) - (06/04)

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