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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103906689
Report Date: 12/11/2019
Date Signed: 12/11/2019 06:09:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MITYA, ALLA FAMILY CHILD CAREFACILITY NUMBER:
103906689
ADMINISTRATOR:MITYA, ALLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 324-1623
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:14CENSUS: 6DATE:
12/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Alla MityaTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Case Management inspection and met with Licensee, Alla Mitya and assistant. LPA explained the reason of the inspection and a tour of the home was conducted. LPA observed that licensee was caring for 6 children of whom 1 was her own child.

LPA requested copies of the children's roster and observed that everything was completed and up to date. Licensee provided proof that herself and 2 assistants were up to date with the immunization requirements. LPA observed that the home was clean and free of toxins and observed that the bathroom door leading to the living room area of the house had a plastic door knob in place. The gate to the kitchen area was also in place.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are cited today. During the exit interview, LPA viewed the LIC9213 being posted and reminded licensee that it needs to be posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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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