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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623538
Report Date: 09/06/2023
Date Signed: 09/06/2023 09:19:06 AM

Document Has Been Signed on 09/06/2023 09:19 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:VOLHINA, TETIANAFACILITY NUMBER:
343623538
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
09/06/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tetiana VolhinaTIME COMPLETED:
09:30 PM
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On September 6, 2023, Licensing Program Analyst (LPA) Michelle Perez, met with licensee Tetiana Volhina for the purpose of a "change of capacity." visit. Upon arrival LPA observed four (4) children in care.
LPA toured the facility to verify the changes made, per the fire department. LPA observed all changes made and reviewed the fire clearance.
Changes made include the fire pull alarm, front door locks and bathroom lock. LPA observed a current fire extinguisher and verified that CPR was current, with an expiration of July 2025.

Effective today: September 6, 2023, licensee is licensed for a large family child care home, the maximum number of children for whom care shall be provided when there is an assistant provider in the home, including children under age 10 who live in the licensee's home and the assistant provider's children under age 10, shall be either:
(1) Twelve children, no more than four of whom may be infants; or
(2) Health and Safety Code Section 1597.465 states:
A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:
(A) At least two of the children are at least six years of age.
(B) No more than three infants are cared for during any time when more than 12 children are being cared for.
(C) The licensee notifies a parent that the facility is caring for two additional school aged children and that there may be up to 13 or 14 children in the home at one time.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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