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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313419
Report Date: 03/16/2021
Date Signed: 03/16/2021 10:52:40 AM

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:PRISYAZHNYUK, YULIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 870-2160
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY:14CENSUS: 7DATE:
03/16/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yulia and Vladislav PrisyazhnyukTIME COMPLETED:
11:15 AM
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A Plan of Correction (POC) inspection was conducted on this date, 3/16/2021, by LPA Valencia and LPA VanZant. The purpose of today's inspection is to verify an A violation cited on 3/5/2021 was corrected. ON 3/5/2021, LPA Valencia cited the facility for violation of Ratio regulation 102416.5(e), the spouse of the licensee was caring for 8 children, 1 of which under 2 years old, and none were over the age of 4; alone for approximately 30 minutes. The licensee later returned to the facilty to provide care and return the facility to compliance with ratio. During today's inspection, it was observed that the facility was in compliance of ratio regulations. The licensee and spouse/assistant was caring for 7 children, 2 of which are under age 2.
It was also observed that the facility has the Notice of Site visit and the reports with A violation cited form 3/5 posted available for parents to review. Notice of site visit has been provided for today's inspection and advised to licensee to post for 30 days. As of today's date, the A violation has been corrected.

An exit interview conducted and Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021
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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