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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621849
Report Date: 06/06/2024
Date Signed: 06/06/2024 11:59:04 AM

Document Has Been Signed on 06/06/2024 11:59 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: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: 16DATE:
06/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Svitlana SoloviovaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 6/6/2024, at approximately 8:40AM, Licensing Program Analyst (LPA) Michelle Perez, arrived for the purpose of a complaint investigation. Upon arrival, LPA witnessed 16 children in care, with three assistants. Licensee was not present. Licensee arrived approximately 30 minutes later.

LPA requested to review the documents of the children in care and documented their names. LPA also observed that five (5) children had been picked up by parents/guardians, leaving eleven (11) children in care.

Licensee provided files for the remaining children. LPA was only able to identify four (4) files of children who were in care, while the remaining seven (7) files were unaccounted for. Licensee stated the files could be in the main house in a separate location, but could not be sure.

LPA explained that files are required for each child in care.

A citation B will be cited today for missing files.

Citation is cited on 809D
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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Document Has Been Signed on 06/06/2024 11:59 AM - It Cannot Be Edited


Created By: Michelle Perez On 06/06/2024 at 11:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SOLOVIOVA, SVITLANA
FACILITY NUMBER: 343621849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2024
Section Cited
CCR
102421(a)(1)

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Children's record: The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). The licensee shall keep the signed and dated notice form for at least three years following termination of service to the child.
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LPA will return to verfiy all children's files are completed and on the permises for each child in care by POC.
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This was not evidenced by: LPA only observing four (4) children's files out of 11 chidlren who were present during today's visit.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Michelle Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024


LIC809 (FAS) - (06/04)
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