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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313419
Report Date: 05/09/2019
Date Signed: 05/09/2019 12:29:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PRISYAZHNYUK, YULIAFACILITY NUMBER:
304313419
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
05/09/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Yulia PrisyazhnyukTIME COMPLETED:
01:00 PM
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An inspection was conducted by LPA Dean Valencia. LPA met with the licensee and the licensee's spouse. This inspection is being conducted in response to two A violations cited on 5/2/19 during an annual inspection and a complaint inspection. On 5/2/19, the facility had 9 children in care, 8 of which were infants. The facility was cited an A violation for having over 4 infants in care, and also cited an A violation for being over its licensed capacity of 8. These were both cited as A violations and determined to be immediate threats to the children's health and safety. In response to the violations the licensee and licensee's spouse stated they will immediately stop providing care for several of the infants, and stated she will not operate out of ratio nor over the licensed capacity. During today's Plan of Correction inspection, it was observed that 4 children were in care, 3 of whom were infants. The licensee and licensee's spouse were present providing care for the 4 children. During today's Plan of Correction inspection, it was observed that the facility was within compliance of ratio and capacity regulations.

Exit interview was conducted, and report was reviewed and discussed with assistants. Notice of Site Visit was posted during the visit. The licensee and licensee's spouse were informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100 per day. The assistants were provided a copy of the appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional manager, address is above on the report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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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