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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623767
Report Date: 03/02/2022
Date Signed: 03/02/2022 10:28:47 AM


Document Has Been Signed on 03/02/2022 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:PARKER, MARK AND BURAKOVSKA, LIUDMYLAFACILITY NUMBER:
343623767
ADMINISTRATOR:PARKER, MARK BURAKOVSKA,LFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(219) 384-1228
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:14CENSUS: 12DATE:
03/02/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Nicole GlazarTIME COMPLETED:
10:30 AM
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On Wednesday March, 2, 2022 at 8:30 AM Licensing Program Analysts Lea Habtom and Tanya Washington met with Nicole Glazar for an unannounced case management inspection. During today's inspection LPA's observed 12 children in care supervised by 3 staff.

LPA's toured the entire home including the off limit areas. At the beginning of February the facility submitted an application to add a co-licensee Nicole Glazar. Community care licensing received all the necessary documents to add Nicole as a co-license. LPA's toured rooms for all three licensee's and observed personal belongs in the rooms.

Current off limit areas of the home are: entire second floor, garage and two back bedrooms in the hallway and master bathroom.

Effective March 2, 2022 Nicole Glazar is added to the license. LPA will issue an updated license upon return to the office.

Notice of site visit was provided and should be posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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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