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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623232
Report Date: 09/16/2019
Date Signed: 09/16/2019 09:10:45 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:PARKER, PRASKOVIIAFACILITY NUMBER:
343623232
ADMINISTRATOR:PARKER, PRASKOVIIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(219) 945-7777
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:14CENSUS: 0DATE:
09/16/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Praskoviia ParkerTIME COMPLETED:
09:15 AM
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Licensing Program Analysts (LPAs) Amy Silva and Seychelle De Luca met with applicant, Praskoviia Parker, for the purpose of a second announced pre-licensing inspection. Also present was assistant and assistant's husband. All individuals subject to criminal background review have obtained a criminal record clearance.

Prior to today's inspection, applicant sent LPA Silva remaining paperwork: assistant's husband's criminal record clearance, assistant's husband's LIC 508 and TB test, and an updated rental agreement. LPA Silva consulted with LPM Peters.

Effective today, this home is recommended for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019
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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