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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622925
Report Date: 03/04/2020
Date Signed: 03/04/2020 02:20:05 PM

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:MARTYNOV, TATYANAFACILITY NUMBER:
343622925
ADMINISTRATOR:MARTYNOV, TATYANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 223-3697
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:14CENSUS: 4DATE:
03/04/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Tatyana MartynovTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Kelly Ferrara and Tanya Washington conducted a Plan of Correction inspection at the facility and met with Licensee Tatyana Martynov. At 1:55 PM, LPAs observed four children in care with the Licensee.

On February 21st, 2020, LPAs issued the following citation: 102417(g)(4) 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.

During today's inspection, LPAs observed that all of the medications were put away and there were no medications stored where they were accessible to the children in care.

LPAs were able to clear the citation today and provided a letter as proof.

There were no deficiencies cited based on today's inspection. LPAs provided a Notice of Site visit that must remain posted for 30 days for parental review.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
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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