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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622304
Report Date: 08/23/2023
Date Signed: 08/23/2023 05:58:19 PM


Document Has Been Signed on 08/23/2023 05:58 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SIKORA-LIU, KAJAFACILITY NUMBER:
393622304
ADMINISTRATOR:SIKORA-LIU, KAJAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 598-3607
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: 3DATE:
08/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Kaja Sikora-LiuTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Corina Beckby met with Licensee, Kaja Sikora-Liu on 08/23/2023 for the purpose of an unannounced plan of correction inspection to clear a deficiency, issued on 07/28/2023.

LPA observed Licensee caring for 3 preschool children during today's inspection. LPA toured the facility and found no deficiencies.

Licensee provided copies of Mandated Reporter Certificate expiring 08/01/25.

LPA walked the perimeter of the pool. Licensee has replaced the previous fence and gate. The new fence is made of mesh, 5 feet in height and the gate is self-closing, meeting Title 22 regulations.

During the visit, Licensee asked to make the backyard on limits again. Request was granted.

All deficiencies cited on 07/28/2023 were cleared effective today. Proof of correction letter was provided for the corrected deficiencies. LPA reviewed report with Licensee, Kaja Sikora-Liu . Appeal Rights were provided. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
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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