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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623098
Report Date: 08/17/2023
Date Signed: 08/17/2023 09:27:42 AM

Document Has Been Signed on 08/17/2023 09:27 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:DAVIDEK, YEKATERINAFACILITY NUMBER:
343623098
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/17/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Yekaterina DavidekTIME COMPLETED:
09:45 AM
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On August 17, 2023, Licensing Program Analysts (LPAs) Amanda Sutter and Pa Dao Vang met with licensee Yekaterina Davidek for the purpose of a plan of correction inspection. Upon arrival, LPA observed 5 children. Licensee's husband was also present at the facility.

LPAs cleared the citation 102417(g)(5) issued on 7/26/2023 for an unfenced pool. LPAs observed that the licensee has drained the pool.

LPAs reviewed this report with Licensee Yekaterina Davidek. Licensee was provided with a notice of site visit that must be posted for 30 days
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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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