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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313624111
Report Date: 03/02/2023
Date Signed: 03/02/2023 09:19:43 AM

Document Has Been Signed on 03/02/2023 09:19 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:PICHSHULINA, MARINAFACILITY NUMBER:
313624111
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
03/02/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Marina PichshulinaTIME COMPLETED:
09:30 AM
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On March 9th, 2022, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Marina Pichshulina for the purpose of an unannounced case management inspection. Licensee has requested to increase from a small family childcare to a large family childcare. Upon LPA's arrival, Licensee’s assistant was present supervising five children, which included one infant and four preschool aged children. All individuals subject to criminal background review have obtained a criminal record clearance. LPA verified with Licensee that her current associations are accurate.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas will remain the same, which are upstairs, the laundry room, the kitchen, and the garage. The upstairs was appropriately barricaded by a fence. Licensee acknowledges that she must contact Community Care Licensing prior to making an off-limit area on-limits and vice versa. A fire clearance was granted on March 1, 2023.

LPA discussed ratios for a large capacity and personnel records. Licensee understands that her own children under the age of 10 count towards the total ratio and capacity.Licensee understands that when there is no assistant present, ratios of a small capacity must be adhered to. LPA provided a copy of CCR Regulation 102416.5 which discusses Ratio and Capacity. LPA discussed required documentation for adult and minor assistants.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. REPORT CONTINUED ON THE FOLLOWING PAGE.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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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: PICHSHULINA, MARINA
FACILITY NUMBER: 313624111
VISIT DATE: 03/02/2023
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In the areas that were evaluated, no deficiencies were observed.

Effective today, March 2, 2023, Licensee’s request for a Large Family Child Care License is approved. Licensee can now provide care for 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information. This facility evaluation report was reviewed and discussed with the licensee.

An exit Interview was conducted and a Notice of Site Visit was provided, which should remain posted for 30 days for parental review.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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