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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619308
Report Date: 04/17/2023
Date Signed: 04/17/2023 10:11:00 AM

Document Has Been Signed on 04/17/2023 10:11 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KISLITSA, VERAFACILITY NUMBER:
343619308
ADMINISTRATOR:KISLITSA, VERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 233-9439
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
04/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Vera KislitsaTIME COMPLETED:
10:30 AM
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On April 17, 2023 at 8:45 AM, Licensing Program Analyst Tanya Washington met with Licensee Vera Kislitsa for an unannounced case management inspection regarding a self-reported incident which occurred on 04/12/2023. Upon arrival, LPA observed two children in care supervised by the Licensee.

LPA toured the facility and conducted an interview with the Licensee. LPA also obtained copies of some children's records.

No Title 22 deficiencies are cited today. Notice of site visit posted and appeal rights are provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2023
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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