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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618055
Report Date: 02/18/2022
Date Signed: 02/18/2022 12:31:15 PM

Document Has Been Signed on 02/18/2022 12:31 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PEREVERTAN, LYUDMILAFACILITY NUMBER:
343618055
ADMINISTRATOR:PEREVERTAN, LYUDMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 849-5982
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
02/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lyudmila PerevertanTIME COMPLETED:
12:45 PM
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On February 18, 2022 Licensing Program Analyst (LPA) Fabiola Diaz met with licensee, Lyudmila Perevertan, for the purpose of a decrease of capacity inspection. Licensee applied to change from a Large Family Child Care Home to a Small Family Child Care Home. LPA observed 3 day care children and an adult assistant present in the home. On today's date licensee's daughters were visiting.

The home has a fenced front yard, a fenced back yard, a play room, a kitchen with a dining area, a living room, 4 bedrooms, 3 bathrooms, and attic. On today's date, licensee updated the off-limit areas. The off-limits areas in the home are bedroom #1, master bathroom, attic, fenced pool/hot tub, fenced property behind backyard. Licensee updated the facility sketch and provided a copy to LPA. Licensee acknowledged that children may never enter the off-limit areas. Licensee acknowledged that if she would like to change an off-limits area to on-limits, she will inform LPA for inspection and approval prior to using the space. All adult residents have criminal record clearances. On today's date LPA was provided with an updated LIC279 by licensee.

During the inspection, LPA requested a tour of the facility. LPA and licensee conducted a health and safety tour inside and out the home. Functioning smoke and carbon monoxide detector and a fire extinguisher that meets Title 22 were observed in the home. The home has barricaded fire place. LPA observed barricaded stairs that lead to the attic.

LPA observed that there were no hazardous items and no cleaning supplies accessible to children. Licensee understands that any poisons must be kept under lock and key. Licensee stated there are no weapons in the home. Toys appear to be safe, and LPA discussed safety regulations of toys and play equipment. The backyard is fenced and gated with toys and play equipment.


LIC 809 continues on LIC 809C...
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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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: PEREVERTAN, LYUDMILA
FACILITY NUMBER: 343618055
VISIT DATE: 02/18/2022
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LPA observed an above ground pool and hot tub on the property which is completely surrounded by a wooden fence that is at least 5 feet high. LPA observed the gate to self-close and self-latch. There are no windows or doors that provide direct access into the pool area. LPA took photos of the pool/hot tub area and fencing for manager's review.

Records, postings, fire drill and reporting requirements were discussed. LPA observed a complete children's roster and children's files. LPA observed current pediatric CPR/First Aid and Mandated Reporter for licensee. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. Licensee was provided with the new Safe Sleep Regulations and information regarding Incidental Medical Services (IMS).

Today 2/18/22, the facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted. Appeal Rights and Notice of Site Visit were provided. LPA observed the licensee post the Notice of Site Visit. The Notice of Site Visit must remain posted for 30 days. In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC809 (FAS) - (06/04)
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