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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415121
Report Date: 12/08/2022
Date Signed: 12/08/2022 02:35:06 PM

Document Has Been Signed on 12/08/2022 02:35 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WARSHAVSKY, LAURENFACILITY NUMBER:
434415121
ADMINISTRATOR:WARSHAVSKY, LAURENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(508) 735-6814
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lauren WarshavskyTIME COMPLETED:
01:15 PM
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On 12/08/2022 at 9:30am Licensing Program Analyst (LPA) Christina Uribe, arrived at the facility for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 9 daycare children and 2 fingerprint cleared assistants, and the facility is within ratio today. Upon arrival LPA met with assistants Analu Niero Prezolo & Paula Pasteri Sales de Andrade as the licensee was not present due to a doctor's appointment. The licensee arrived back at the facility around 11:10am and the remainder of the inspection was conducted with her. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 8:30am-5:30pm.

The home is a single story home with 3 bedrooms, 2 bathrooms, living room, kitchen, family room, laundry room, garage and back yard. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. The OFF-LIMIT AREAS are the bedrooms, one bathroom, living room, kitchen, laundry room, & garage and are inaccessible to children by locked doors, safety gates and visual supervision. The ON-LIMIT AREAS are the family room, front bathroom, and backyard.

The facility’s outdoor play space is located in the backyard of the home. The play structure, equipment, and fence are all in safe condition free from hazards which could pose a risk to children in care. There is ample shade available and gates are locked at all times while children are in the yard.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide, telephone and fully stocked first aid kit. There are no pools, hot tubs or any other bodies of water present at the time of the inspection. Per licensee, there are no firearms on the premises and there is one dog that is kept in the off limit areas during operating hours.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: WARSHAVSKY, LAUREN
FACILITY NUMBER: 434415121
VISIT DATE: 12/08/2022
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The licensee completed the Health and Safety training, CPR/First Aid certification for the licensee expires on 01/08/24. The licensee is in compliance with the immunization laws..

The licensee conducts and documents fire and disaster drills at least twice a year and the last conducted drill was today, 12/08/22 as the children performed a fire drill during the testing of the smoke detectors by LPA Uribe. All required forms are posted and visible for public review.

LPA Uribe reviewed 5 children’s files and personnel records. The facility does not have any children enrolled under the age of 24 months and therefore does not have the need for documents regarding Safe Sleep Regulations for infants. There is a current roster available for review and copy obtained. The facility does have liability insurance which is valid through 09/27/23.



LPA reviewed medication, storage, and records for compliance. 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.

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.

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.

Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: WARSHAVSKY, LAUREN
FACILITY NUMBER: 434415121
VISIT DATE: 12/08/2022
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No deficiencies cited during today's inspection. Please see attached advisory note pages for information on technical violations issued today.
  • Technical Violation: The fireplace in the on-limit family room does have a barricade however it is in need of being replaced or re-secured.
  • Technical Violation: One child's Identification & Emergency form (LIC 700) needs the physician/dentist information and another child's Consent for Emergency Medical Treatment (LIC 627) form needs the parent's signature.
  • Technical Violation: One child's file does not have a signed Parents' Rights (LIC 995) form.
  • Technical Violation: Licensee's mandated reporter certificate expired one week ago today (12/01/22) and needs to be renewed.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Lauren Warshavksy.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
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