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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617939
Report Date: 03/24/2022
Date Signed: 03/25/2022 08:06:20 AM


Document Has Been Signed on 03/25/2022 08:06 AM - It Cannot Be Edited

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:PEREVOZCHIKOV, VITALIY AND VERAFACILITY NUMBER:
343617939
ADMINISTRATOR:PEREVOZCHIKOV, VITALIYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 723-3951
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:14CENSUS: 0DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Vera and Vitaliy PerevozchikovTIME COMPLETED:
12:00 PM
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On Thursday, March 24th, 2022 at 10:15 AM, Licensing Program Analyst (LPA) Tanya Washington conducted an unannounced Required 1 year annual inspection and met with Licensees, Vera and Vitaliy Perevozchikov. There were no day-care children present during today's inspection. The off-limit areas include: entire second floor, garage, both downstairs bedrooms and garden area. Licensee acknowledged that children may never enter these off-limits area. Licensee stated there are no new residents in the home since licensure. The hours of operation are Monday through Friday from 8:00 AM to 6:00 PM.

LPA observed current CPR/First Aid certificates for both Licensees which expire on 12/2023. LPA reviewed one child's file. LPA observed that there were no hazardous items accessible to children. The fireplace in the home is properly barricaded. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe. There are no bodies of water on the premises. Licensee stated that there are no weapons in the home. LPA discussed current COVID guidelines with Licensee.

LPA observed a current fire drill log and children’s roster. Licensee is exempt from Mandated Reporter training due to language barrier. LPA explained that the OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

REPORT CONTINUED ON NEXT PAGE LIC809C

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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: PEREVOZCHIKOV, VITALIY AND VERA
FACILITY NUMBER: 343617939
VISIT DATE: 03/24/2022
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This facility does not currently provide Incidental Medical Services- IMS. 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.

LPA provided Licensee the Safe Sleep PIN 20-24 CCP and Infant Individual Sleeping Plan (LIC9227). Licensee stated that she does not currently have any children under the age of two years old enrolled in her facility.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA verified that the licensing annual fees are current.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, no Tittle 22 deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with both Licensees Vera and Vitaliy Perevozchikov.

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

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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