<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617976
Report Date: 06/18/2019
Date Signed: 06/18/2019 11:34:13 AM

COMPREHENSIVE INSPECTION
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:KHRISTUCHENKO, LYUDMILAFACILITY NUMBER:
343617976
ADMINISTRATOR:KHRISTUCHENKO, LYUDMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 246-8085
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 2DATE:
06/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Lyudmila KhristuchenkoTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Tanya Washington and Aruna Sridharan met with Licensee, Lyudmila Khristuchenko for the purpose of an unannounced annual random inspection. LPAs observed 2 school age children in care. All individuals subject to criminal background review have obtained a criminal record clearance. Facility operates Monday- Saturday from 7:00 AM to 11:00 PM.

Off limit areas include entire second floor and garage. LPA observed a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated that there are no weapons in the home. There are no accessible bodies of water on the premises. There is a creek behind the backyard fence, Licensee has a gate leading out to the creek. The gate and the fence barricading the creek meet Title 22 Regulations. LPAs observed Cascade dish washing soap under the kitchen sink and lighters in the kitchen drawers which were unlatched. LPAs also observed matches, essential oils, cologne, hand sanitizer and Melatonin sleeping medication on a console table in the living room area. In the bathroom accessible to children LPAs observed miscellaneous cleaning items, and two bottles of alcohol, one sealed, one open. Comfortable accommodations were observed. LPAs observed children's scooter and bicycle in the backyard area with missing bar cover and a small children's trampoline in disrepair. Fire place located in the dining room is properly barricaded.

A health and safety inspection was conducted in all areas accessible to children. Licensee utilizes the backyard for outdoor play. Licensee is aware that 100% visual supervision is required in any unfenced areas.

Children's records were reviewed. Emergency information and signed parents rights were on file. Current pediatric CPR and first aid certification was verified for Licensee (exp. date 09/27/2019). LPAs observed an updated children's roster. Licensee was reminded to log and conduct fire drills at least once every 6 months.

Report continues on 809-C.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: KHRISTUCHENKO, LYUDMILA
FACILITY NUMBER: 343617976
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2019
Section Cited
CCR
102417(g)(4)
1
2
3
4
5
6
7
Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced; LPAs observed
1
2
3
4
5
6
7
Licensee removed all of the items from the area accessible to children and relocated them to the garage.
Licensee understands that all items with 'keep out of reach' label must remain inaccessible to children.
8
9
10
11
12
13
14
accessible cleaning compounds, medication, essential oils, cologne, bottles of alcohol under the bathroom sink, matches, and lighters. This is an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
Deficiency is cleared during the visit.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: KHRISTUCHENKO, LYUDMILA
FACILITY NUMBER: 343617976
VISIT DATE: 06/18/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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

Proof of required vaccines for the Licensee have been verified.

Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

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.


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

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: KHRISTUCHENKO, LYUDMILA
FACILITY NUMBER: 343617976
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
CCR
102417(d)
1
2
3
4
5
6
7
The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced, LPAs observed children's size trampoline in disrepair, a bicycle and scooter with missing handle bar cover.
1
2
3
4
5
6
7
Licensee removed the broken toys.

Defficiency is cleared today.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4