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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618276
Report Date: 02/11/2025
Date Signed: 02/12/2025 07:32:16 AM

Document Has Been Signed on 02/12/2025 07:32 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KISELEV, YELENAFACILITY NUMBER:
343618276
ADMINISTRATOR/
DIRECTOR:		KISELEV, YELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 704-8155
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
02/11/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Yelena KiselevTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On Tuesday, February 11, 2025, Licensing Program Analyst (LPA) Amanda Sutter met with Licensee Yelena Kiselev for the purpose of an unannounced plan of correction inspection. LPA observed 3 children. LPA did not observe any other adults present in the home. Licensee's daughter was also present in the home. All individuals subject to criminal background review have obtained a criminal record clearance.

LPA observed one awake children and two napping children. Both the napping children are over 2 years old. LPA observed the napping children in age-appropriate beds. LPA observed two pack 'n plays in the nap room. LPA did not observe any children sleeping in the pack 'n plays. LPA will clear the citation cited on 1/16/2025, for deficiency 102425(a)(1).

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative Yelena Kiselev.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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