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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617934
Report Date: 07/22/2019
Date Signed: 07/22/2019 10:53:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:LOBKOV, VERAFACILITY NUMBER:
343617934
ADMINISTRATOR:LOBKOV, VERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 799-9532
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 13DATE:
07/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Vera LobkovTIME COMPLETED:
11:05 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Tanya Washington and Seychelle De Luca met with Licensee Vera Lobkov for the purpose of an unannounced annual/random inspection. LPAs observed 13 children supervised by the Licensee and her minor assistant. All individuals subject to criminal background review have obtained a criminal record clearance. Facility operates Monday- Saturday from 6:00 AM to 6:00 PM (weekend time varies).

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas master bedroom/bathroom, office, both sides of the yard, and detached in-law suite located in the backyard. Licensee acknowledges that she must contact CCL to make an off-limit on-limits or vice versa. LPAs observed a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. There are no accessible bodies of water on the premises. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. Outdoor play area is fenced.

Children's records were reviewed. LPAs printed out an updated LIC995A, Parent's Rights form and reviewed Safe Sleep Concepts with the Licensee. Current pediatric CPR and first aid certification was verified for Licensee, her spouse and father in law all certificates expire on the same day of 11/27/2020. Proof of required vaccines for Licensees has been verified.

LPAs verified that the annual Licensing fees are current.

Continues on LIC809C
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: LOBKOV, VERA
FACILITY NUMBER: 343617934
VISIT DATE: 07/22/2019
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This provider is currently not providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this report.



No deficiencies are observed during the annual inspection.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
LIC809 (FAS) - (06/04)
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