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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002057
Report Date: 01/12/2024
Date Signed: 01/12/2024 03:28:54 PM

Document Has Been Signed on 01/12/2024 03:28 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:BERENSHTEYN, GALINAFACILITY NUMBER:
384002057
ADMINISTRATOR:BERENSHTEYN, GALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 819-1714
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
01/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Jane YurkevichTIME COMPLETED:
03:45 PM
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On January 12, 2024, at approximately 2:50PM, Licensing Program Analysts (LPAs) Ly, Gil and Zaragoza conducted an unannounced Plan of Correction visit and met with Licensee's daughter Jane Yurkevich during the visit. Purpose of the inspection was explained. Per Licensee's daughter Licensee is not at home. She has left for the the long weekend with her grand children. There were 4 children, Licensee's daughter and 1 Assistant present during the visit.

On December 15, 2023, the following deficiencies were being cited during an annual inspection:
-Facility was cited for not conducting disaster drill.
-Licensee was cited for not being present at the day care 80% of the operating hours.
-Licensee's Pediatric CPR/First Aid was expired.
-Assistant did not have proof of Child Abuse Mandated Reporter Training.

During today's visit, LPAs are able to clear the deficiencies of facility conducted disaster drill on 12/21/2023 and properly documented, Licensee has proof of Pediatric CPR/First Aid on file and Assistant has completed the Child Abuse Mandated Reporter Training.

On this day, LPAs have been informed Licensee have decided to retire and will submit the original copy of the license to the department.


A copy of this report and appeal rights were discussed and left with the Director whose signature on this form confirm receipt of these reports.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
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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