343622904-6-15-2021-03-CC-JHOA-C3ZMQ8-20210615094820

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622904
Report Date: 06/15/2021
Date Signed: 06/15/2021 09:48:39 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:	TIMOFEYEVA, VERA		FACILITY NUMBER:	343622904
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	06/15/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Vera Timofeyeva		TIME COMPLETED:	10:00 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	On Tuesday, 06/15/21, at 8:00am, Licensing Program Analyst (LPA) Jan Hoshida conducted an unannounced case management inspection for the purpose of a capacity increase from 8 to 14 children and met with Licensee Vera Timofeyeva. LPA toured all areas of the single story home that are accessible to children. Upon arrival, LPA observed four children with Licensee. Licensee stated there are no new residents in the home since licensure. Off-limit areas include bedrooms #1, #3, and #4, laundry room, and garage. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a current roster of the enrolled children and fire drill log. The Fire Safety Inspection Clearance has been received from the Sacramento Metropolitan Fire Department on 06/10/21 and the home has been cleared for up to 14 children. LPA observed cleaning supplies properly stored out of reach of children. LPA observed medications out of reach of children . Fireplace is properly covered. Licensee stated there are no weapons in the home. Fire extinguisher (2A10BC), smoke detector, and carbon monoxide meet regulation. LPA observed a fire pull installed by the front door of the home. Toys appear to be clean and safe. The backyard is fenced. Licensee understands that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed changes. Large family child care home capacity limitations were reviewed during today's visit. Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: TIMOFEYEVA, VERA	FACILITY NUMBER: 343622904
	VISIT DATE: 06/15/2021

NARRATIVE

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LPA observed a current CPR/First Aid certificate that expires 10/2022. LPA reviewed children’s files. LPA discussed changes in sleep regulations and LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA reviewed Infant Individual Sleeping Plan (LIC 9227) for children under 12 months and sleep logs for the children under two years of age. LPA discussed current COVID guidelines with Licensee.

LPA advised licensee to visit the licensing website at http://www.ccld.ca.gov for current forms, laws, regulations and legislation. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Effective today's date, 06/15/2021, LPA will approve the capacity increase to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. Exit interview conducted. Notice of Site Visit posted.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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