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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622904
Report Date: 02/11/2022
Date Signed: 02/17/2022 04:25:20 PM


Document Has Been Signed on 02/17/2022 04:25 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:TIMOFEYEVA, VERAFACILITY NUMBER:
343622904
ADMINISTRATOR:TIMOFEYEVA, VERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 829-0332
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:14CENSUS: 9DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Vera TimofeyevaTIME COMPLETED:
11:30 AM
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On 2/11/22 at, 10:10AM an inspection was made to the facility by Licensing Program Analyst (LPA), Mikah Martinez. A review of staff records on 2/9/22 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home. At 10:50AM the home was toured inside and outside. The licensee and one assistant were supervising 9 children, and operating within the licensed capacity and ratio requirements. The facility's operating hours are 5-5, Monday- Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are 3 bedrooms and one bath along with the garage, and were made inaccessible by locked door. Poisons are locked and under the sink. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of reach of children. The fireplace has been made inaccessible by being blocked with toys, however, the licensee stated they have never used the fireplace. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (916) 862-1086
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2022
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: TIMOFEYEVA, VERA
FACILITY NUMBER: 343622904
VISIT DATE: 02/11/2022
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There are cribs/play yards available for napping infants. Cribs have firm mattresses and are free of loose objects. Bedding is laundered weekly, and soiled bedding is stored inaccessible to infants. Napping infants are checked on every 15 minutes, and checks are documented on logs in the child's file. No infants were observed to be swaddled, and infants under 12 months are placed on their backs for sleeping. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard. Eight children's records were reviewed at 10:30; required emergency information forms were observed to be on file. Individual Sleeping Plans were on file for infants under 12 months of age. The licensee has completed Mandated Reporter Training. The licensee and all employees have the required immunization's on file. The licensee has current pediatric CPR and First Aid certification, which expire on 10/22. This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's Visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (916) 862-1086
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
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