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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619090
Report Date: 04/26/2022
Date Signed: 04/26/2022 04:27:01 PM

Document Has Been Signed on 04/26/2022 04:27 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PSHEHORLINSKA HALYNA AND PSHEHORLINSKYY OLEKSANDRFACILITY NUMBER:
343619090
ADMINISTRATOR:PSHEHORLINSKA, HALYNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 284-1320
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Halyna Pshehorlinska and Oleksandr PshehorlinskyyTIME COMPLETED:
01:30 PM
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On Tuesday, April 26, 2022, at 11:15 AM, Licensing Program Analyst (LPA) Tanya Washington conducted an unannounced Required 1 year annual inspection and met with Licensee, Oleksandr Pshehorlinskyy. Licensee Halyna Pshehorlinska arrived to the facility shortly after LPAs arrival. There were no daycare children during today's inspection. The off-limit area include: master bedroom, garage and separate loft where Licensee's son and daughter in law live and an outdoor shed located on the left side. Licensee acknowledged that children may never enter these off-limits area. Licensee stated there are no new residents in the home since licensure. The hours of operation are Monday through Friday from 8:00 AM to 6:00 PM. During today's inspection Licensee informed LPA that they have added a playhouse/ shed in the backyard. LPA looked inside the shed and observed toys and children's equipment. Licensee stated that children play inside the play house for short periods of time while playing outdoors. Effective today the play house is approved for use.

LPA observed current CPR/First Aid certificates for both Licensees, Halyna's expires 08/2022 and Oleksandr's expires 04/2023. LPA reviewed five children’s files. LPA observed that there were no hazardous items accessible to children. There is no fireplace in the home. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe. There are no bodies of water on the premises.

LPA observed a current fire drill log and children’s roster. Proof of AB1207 Mandated Reporter Training was observed for all adults who provide care to children. LPA explained that the OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. Licensee is aware that she has to renew it every two years.
REPORT CONTINUED ON NEXT PAGE LIC809C
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: PSHEHORLINSKA HALYNA AND PSHEHORLINSKYY OLEKSANDR
FACILITY NUMBER: 343619090
VISIT DATE: 04/26/2022
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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.

This facility does not currently provide Incidental Medical Services- IMS. 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: http://www.ada.gov/childqanda.htm.



LPA provided Licensee the Safe Sleep PIN 20-24 CCP and Infant Individual Sleeping Plan (LIC 9227). LPA discussed the safe sleep regulations with licensee 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.
LPA checked facilities fees and confirmed that it is up to date.

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.

In the areas that were evaluated, no Tittle 22 deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Halyna Pshehorlinska.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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