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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408658
Report Date: 02/05/2020
Date Signed: 02/05/2020 12:39:28 PM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:VOLOKH, REGINAFACILITY NUMBER:
073408658
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
02/05/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Regina VolokhTIME COMPLETED:
01:00 PM
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LPA, Hollie, met with Licensee Ms. Regina Volokh, for the purpose of a Required one year visit. The facility was visited for a Random visit in November 2019 with no deficiencies and there have been no significant changes, other than the licensee applying for an Increase of Capacity. Please see Case Management visit dated today 02-05-2020.
There are six children present and the licensee's assistant, Vera Vasilyeva.
THERE ARE NO DEFICIENCIES CITED FOR THE REQUIRED ONE YEAR VISIT.



SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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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