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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700364
Report Date: 05/13/2022
Date Signed: 05/13/2022 09:48:07 AM

Document Has Been Signed on 05/13/2022 09:48 AM - 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:PIVOVAROVA, ANASTASIIA & PIVOVAROV, ARTEMIYFACILITY NUMBER:
435700364
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Anastasiia Pivovarova & Artemiy PivovarovTIME COMPLETED:
09:45 AM
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On Thursday 05/13/2022, at approximately 9am Licensing Program Analyst Sabina Dodoo, met with Licensees Anastasiia Pivovarova and Artemiy Pivovarov, to conduct an Announced Pre-Licensing Inspection. Present during the inspection was Licensees Anastasiia Pivovarova and Artemiy Pivovarov. Licensees have a 12 years old son and a 9 years old daughter.

The home is a single family, two story home with an attached garage. Licensing Program Analyst and Licensees toured the inside and outside of the home to conduct a health and safety inspection. The home consist of living(converted into an activity room), a kitchen, a dining area, a hallway bathroom, a hallway bedroom, 2 hallway bedrooms on the second floor, an upstairs hallway bathroom, and a master bedroom with a bathroom located on the second floor. The home has a working smoke detector, a working carbon monoxide and a fully charged fire extinguisher 3A 10 40 BC. The home has adequate heating and ventilation for the safety and comfort of children in care. Per licensee there are no firearms in the home. Licensees have a current copy of a lease and both CPR/ First Aide are current for both licensees from 02/27/2022 to 02/27/2024. After a review of the file the applicants have completed the Mandated Reporter Training which will expire on 02/27/2024. Licensees are adhering to the immunization laws as it is required for all day care providers.

Per Licensee the operating hours of the Family Child Care Home will be Monday through Friday from 7:30am to 5pm.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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: PIVOVAROVA, ANASTASIIA & PIVOVAROV, ARTEMIY
FACILITY NUMBER: 435700364
VISIT DATE: 05/13/2022
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Licensee has requested the following rooms to be ‘on limits’ to day-care children: living room, dining area, kitchen, bedroom and bathroom on first floor, 2 hallway bedrooms on the second floor and the hallway located on the second floor. The backyard is also on limits for day-care children.

Licensee has requested the following rooms be ‘off limits’ to day-care children: master bedroom, master bathroom on the second floor, the upstairs hallway bathroom, and the garage .

LPA Dodoo, discussed and reiterated documents that go into a child’s facility file and documents which are to be posted for parental view. There are no bodies of water on the premises.

Licensees Anastasiia Pivovarova and Artemiy Pivovarov, 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 Sabina Dodoo, discussed the safe sleep regulations with licensees Anastasiia Pivovarova and Artemiy Pivovarov, 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 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.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email [email protected] to be included in the Child Care Quarterly Updates distribution list.

This home is being recommended for licensure.

Exit interview conducted and report was reviewed with the licensees Anastasiia Pivovarova and Artemiy Pivovarov.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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