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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415121
Report Date: 06/26/2024
Date Signed: 06/26/2024 12:38:48 PM

Document Has Been Signed on 06/26/2024 12:38 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
OAKLAND SOUTH EAST, 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: 3CENSUS: 3DATE:
06/26/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Tamiris Da CruzTIME COMPLETED:
01:00 PM
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On 06/26/2024 at 10:45am Licensing Program Analyst (LPA) Christina Uribe, arrived at the facility for an UNANNOUNCED ANNUAL INSPECTION and met with assistant, Tamiris Da Cruz. Present for the inspection were 3 daycare and the facility is within ratio today. One child is under 24 months of age, and two children are over the age of 2 years. The licensee is not present at the time of the inspection as the assistant stated that she was tending to her own children outside of the home during the inspection. 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. There are no pools, hot tubs or any other bodies of water present at the time of the inspection.

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 detector, telephone and fully stocked first aid kit. 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 4 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WARSHAVSKY, LAUREN
FACILITY NUMBER: 434415121
VISIT DATE: 06/26/2024
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The assistant's CPR/First Aid certificate expires on 10/14/25 and her mandated reporter certificate expires on 08/22/25. A current copy of the licensee's CPR/First Aid and mandated reporter certificates were unavailable for review. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 01/09/24. All required forms are posted and visible for public review.

Records: LPA Uribe reviewed 3 children’s files and personnel records. Sleep Charts for sleeping infants were reviewed and within compliance of the Safe Sleep Regulations. There is a current roster available for review. The facility does have liability insurance which is valid through, however proof of the current policy was unavailable for review. Assistant is cleared and associated to the facility.



Provider Information Notices (PINs) & Quarterly Updates: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders, by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.
CCLD Inspection Process: 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.
Criminal Record Clearance: Facility representative 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.

Page 2 of 4 ***Continued on LIC 809C***

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

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WARSHAVSKY, LAUREN
FACILITY NUMBER: 434415121
VISIT DATE: 06/26/2024
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Safe Sleep: LPA discussed the safe sleep regulations with facility representative 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 an additional resource. LPA also informed facility representative 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): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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/resources/child-care-centers/.

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

Megan’s Law: During the exit interview, the facility representative, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: 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 3 of 4 ***Continued on LIC 809C***
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WARSHAVSKY, LAUREN
FACILITY NUMBER: 434415121
VISIT DATE: 06/26/2024
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The annual licensing fees for the facility were due on 03/06/2024 and are overdue resulting in the assessment a late fee of as of 05/30/24. At this time the amount of $210.00 is overdue and needs to be paid in full. As a condition of the license, fees must be paid in full and on time in order to avoid accrued late fees and the temporary suspension of the license. LPA Uribe gave licensee information to be able to make a payment online to reconcile the account. Fees can be paid online at https://www.cdss.ca.gov/inforesources/community-care/licensing-fees

No deficiencies cited, five Advisory Notes are being issued today:

  • Advisory Note (TV): Two children's files do not include their updated immunization records.
  • Advisory Note (TV): The licensee's current CPR/First Aid certificate is not available for review.
  • Advisory Note (TV): The licensee's current Mandated Reporter certificate for Child Care Providers is not available for review.
  • Advisory Note (TV): The licensee's current liability insurance record is not available for review.
  • Advisory Note (TV): The Facility Roster (LIC 9040) form needs to be updated to include the exact date of which each child starts and ends enrollment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the assistant, Tamiris Da Cruz.

Page 4 of 4 ***End of Report***

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

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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