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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622055
Report Date: 06/02/2022
Date Signed: 06/02/2022 12:34:29 PM

Document Has Been Signed on 06/02/2022 12:34 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: 17DATE:
06/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Natalia BoykoTIME COMPLETED:
12:45 PM
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On June 2 at 9:15 am LPAs Lea Habtom and Jeremey McClain arrived at Natalia' Boyko's home to clear the deficiency for children being in an off limits area cited on May 27, 2022. Upon arrival there were 17 children being supervised by 3 staff and licensee both inside and outside of the home. LPAs toured the home inside and out including off limit areas and confirmed that no children were in any off limit areas. There were no other adults present in the home at the time of visit. There was one infant, 7 month old, sleeping in a pack-n-play on a recalled item, boppy sleeper, with a blanket. LPA J. McClain notified licensee that infants cannot sleep with the boppy pillow and blankets. Licensee agreed to not use any recalled items or blankets and will review infant safe sleep regulations. At 10:50 am there was a census of 12 children.

This is a repeat violation within 1 year that licensee exceeded the limitations of her license of up to 14 children. Civil penalty has been assessed during today's visit. There are 2 Type A deficiencies cited during today's visit. For citation information see 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: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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 06/02/2022 12:34 PM - It Cannot Be Edited


Created By: Lea Habtom On 06/02/2022 at 11:04 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
, 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: 06/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2022
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 will be cleared by a visit.
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There were 17 children present at the time of the 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
06/03/2022
Section Cited
CCR102425(b)

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102425(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement was not met as evidenced by:
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Licensee removed the boppy and put it in an off limitis area, garage, and states she will not use the boppy lounger. LPA L. Habtom provided safe sleep regulations and made licensee aware of the recalled boppy lounger.
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A 7 month child was sleeping in a pack-n-play on a boppy lounger with a blanket. 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: 06/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022


LIC809 (FAS) - (06/04)
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