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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617976
Report Date: 03/17/2023
Date Signed: 03/17/2023 03:54:13 PM


Document Has Been Signed on 03/17/2023 03:54 PM - 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:KHRISTUCHENKO, LYUDMILAFACILITY NUMBER:
343617976
ADMINISTRATOR:KHRISTUCHENKO, LYUDMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 367-2191
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 6DATE:
03/17/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Evelina KorzhukTIME COMPLETED:
04:10 PM
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On Friday. March 17, 2023 Licensing Program Analysts (LPA) Lea Habtom met with assistant/daughter, Evelina Korzhuk, for the purpose of a case management inspection. Upon arrival, LPA observed a census of 1 infant and 5 preschool children supervised by 2 staff. All individuals subject to criminal background review have obtained criminal record clearance.

The purpose of today's inspection is to update the off-limit areas to include the downstairs bedroom to be on-limits. LPA L. Habtom inspected the room downstairs and determined that the room is safe to be used as a day care room. LPA L. Habtom also cleared a citation issued on 1/25/2023 during the annual inspection for proof of staff immunization's.

Effective March 17, 2023 LPA L. Habtom has updated the off-limit rooms to be the entire 2nd floor and garage.

There were no deficiencies cited during today's visit. An exit interview was conducted. Notice of Site Visit provided and shall remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023
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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