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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622055
Report Date: 06/06/2022
Date Signed: 06/06/2022 10:28:04 AM


Document Has Been Signed on 06/06/2022 10:28 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:BOYKO, NATALIA & BARANOVA, TAMARAFACILITY NUMBER:
343622055
ADMINISTRATOR:BOKYO, N. & BARANOVA, T.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 470-6898
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:14CENSUS: 10DATE:
06/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Natalia BoykoTIME COMPLETED:
10:45 AM
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On June 6, 2022 an unannounced plan of correction inspection was conducted by Licensing Program Analysts Lea Habtom and Amanda Blesi. At 9:15 am LPAs Lea Habtom and Amanda Blesi arrived at Natalia Boyko's home to clear the deficiency cited on June 2, 2022 for licensee exceeding the limitations of her license. Upon arrival there were 10 children, 2 being under 2 years of age, being supervised by 2 staff outside of the home. Around 9:30 am LPAs toured the home inside and out including off limit areas and confirmed that no children were in any off limit areas. At the time of inspection there were no adults and licensee present in the home. Around 10:00 am licensee, Natalia Boyko, arrived. On June 6, 2022, LPAs cleared the deficiency for licensee exceeding the limitations of the license. Licensee was reminded to always follow the limitations of the license and to not exceed 14 children.


SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
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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