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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621849
Report Date: 06/13/2024
Date Signed: 06/13/2024 02:56:18 PM

Document Has Been Signed on 06/13/2024 02:56 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:SOLOVIOVA, SVITLANAFACILITY NUMBER:
343621849
ADMINISTRATOR/
DIRECTOR:		SOLOVIOVA, SVITLANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 297-8262
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/13/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Svitlana SoloviovaTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA), Michelle Perez arrived on June 13, 2024, at approximately 2PM for the purpose of clearing deficiencies cite on June 6, 2024.

The deficiencies cleared during today's visit, was a type A citation for an unassociated adult assistant, failure to transfer criminal record clearances to the facility. LPA did not witness the assistant present during today's visit.
Another citation A for over ratio on June 6, 2024, with 16 children present on that day. LPA observed 10 children in care during today's visit.

A citation B, for children's records. The facility failed to keep all records of all children in care, when LPA reviewed children's filed on June 6, 2024. LPA observed all the files of children present during today's visit.

LPA advised that all children's files files MUST have licensing the form LIC 9224 "Acknowledgement of receipt of licensing reports" for one-year, which was provided on June 6, 2024, when initial citations were issues.

During today's visit, LPA was able to clear all deficiencies from June 6, 2024.


This report was review with licensee Svitlana Soloviova. A notice of site visit was also provided and will be posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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