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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622055
Report Date: 05/27/2022
Date Signed: 05/27/2022 03:22:21 PM

Document Has Been Signed on 05/27/2022 03:22 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:BOYKO, NATALIA & BARANOVA, TAMARAFACILITY NUMBER:
343622055
ADMINISTRATOR:BOKYO, N. & BARANOVA, T.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 470-6898
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 16DATE:
05/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Natalia BoykoTIME COMPLETED:
03:45 PM
NARRATIVE
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On May 27, 2022 around 9:30 am Licensing Program Analyst (LPA) Lea Habtom arrived at Natalia Boyko and Tamara Baranova to open a complaint. LPA L. Habtom gained entry into the home from the outside gate by licensee Natalia Boyko who pulled in behind. Upon arrival, LPA L. Habtom meet with Natalia Boyko who was the only adult present in the home. Today's census consisted of 3 infants, 7 preschool and 6 school age children being supervised by 3 adults. LPA L. Habtom observed 11 children both inside and outside of the on limits area of the day care home being supervised by 3 staff. As the licensee continued to guide LPA L. Habtom through the home 5 other children were observed, ages 3, 4,7, 8, 13 in the room to the right with no adult supervision. The children were observed on the third floor of the home in a room that is off limits.

There are 2 Type A citations being cited during today's visit. See attached 809-D.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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 05/27/2022 03:22 PM - It Cannot Be Edited


Created By: Lea Habtom On 05/27/2022 at 01:13 PM
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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BOYKO, NATALIA & BARANOVA, TAMARA
FACILITY NUMBER: 343622055

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/31/2022
Section Cited
CCR
102416.5(a)

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102416.5 (a)The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement was not met as evidenced by:
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Licensee contacted parents to pick up children during the inspection. Prior to LPA leaving the facility LPA observed 10 children present. Deficiency corrected at the time of the visit,
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There were 16 children present at the time of inspection. Large license is granted for 14 children. This poses an immediate health and safety risk to children in care.
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Type A
06/01/2022
Section Cited
CCR102416.3(a)(6)

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(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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Licensee was reminded to never allow children in off limit areas.
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This requirement was not met as evidenced by:
LPA Lea Habtom observed 5 children ages 3, 4,7,8, 13 on the third floor in the room to the right with no adult supervision. This poses an immediate health and safety risk to children in care.
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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:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022


LIC809 (FAS) - (06/04)
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