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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618557
Report Date: 02/06/2024
Date Signed: 02/06/2024 03:36:26 PM

Document Has Been Signed on 02/06/2024 03:36 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GUSEVA, VERAFACILITY NUMBER:
343618557
ADMINISTRATOR:GUSEVA, VERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 334-3327
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
02/06/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Vera GusevaTIME COMPLETED:
03:40 PM
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At 3:05pm on 2/6/2024, Licensing Program Analyst (LPA) Matthew Gallo met with licensee Vera Guseva for the purpose of a plan of correction visit. Upon arrival, LPA observed a total census of 2 school aged children.
Licensee was previously cited a Type A deficiency on 2/1/2024 due to the presence of an adult in the home whose criminal record clearance was no longer valid. The plan of correction dictated that the relevant adult move out of the home, and stated that the LPA would conduct a return visit to ensure compliance with this requirement. At 3:10pm, LPA observed the room of the relevant adult to be vacant. Licensee reaffirmed their understanding that this adult cannot resuming living in the home or be present during child care operating hours until a criminal record exemption is obtained.

The plan of correction has been met, and the deficiency cited on 2/1/2024 has been cleared.

Exit interview conducted and report was reviewed with licensee Vera Guseva. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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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