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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409090
Report Date: 11/30/2021
Date Signed: 11/30/2021 01:44:55 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:LEVINA, VALENTINAFACILITY NUMBER:
073409090
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
11/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Valentina LevinaTIME COMPLETED:
02:00 PM
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On 11/30/21 at 1:00 PM Licensing Program Analysts (LPAs) Monica Mathur and Ashley Curry conducted an unannounced Case Management inspection at Valentina Levina's family day care home. LPAs met with Licensee, Vaentina and explained the purpose of today's inspection which is to ensure compliance of regulations cited on an unannounced annual inspection conducted on 10/13/21 where facility was cited two Type A deficiencies for Criminal Record Clearance and Out of Ratio.

During today's inspection there were 7 children present (6 preschool age napping; 1 school age awake) with 2 Assistants and Licensee, All adults are fingerprint cleared and associated to the license, They are in ratio compliance today, LPAs observed there was visual supervision of all children, all dangerous items were stored inaccessible to children and all files were completed. Children files contained signed copies of Statement Acknowledging Receipt of Licensing reports LIC9224 of report given on 10/13/21.

No deficiencies were cited today. At 1:45 PM exit interview was conducted with Licensee, Valentina. A NOTICE OF SITE VISIT WAS ISSUED, TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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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