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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624944
Report Date: 04/04/2024
Date Signed: 04/04/2024 11:25:37 AM

Document Has Been Signed on 04/04/2024 11:25 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:SHAVELKOVA, ELENAFACILITY NUMBER:
343624944
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 3DATE:
04/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Elena ShavelkovaTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On Thursday, April 4, 2024 at 11:00 AM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee Elena Shavelkova for an unannounced case management inspection to increase capacity to the maximum number of 14 children. During today's inspection LPA observed Licensee providing care and supervision to three children. Facility hours and days of operation are Monday- Friday from 7 AM to 10:30 PM.

Licensee owns the home and control of property was previously submitted to the Regional Office. LPA discussed and provided a visual of capacity/ ratio options with and without an assistant. LPA also reminded Licensee that when her or an assistant are left alone with children they divert to small license ratio/ capacity requirements.

On April 2, 2024, Sacramento Metropolitan Fire Department granted a fire clearance to operate a large license.

The off limit areas in the home consist of all bedrooms and laundry room. The Licensee acknowledged that children may never enter these off-limit areas. Off-limit areas will remain inaccessible to children by closed door and/or supervision. Toxic and hazardous items are inaccessible to children.

Per Licensee there are no weapons on the premises. Infant safe sleep guidelines were discussed.

Licensee's CPR and First Aid is valid until 11/2025.

EFFECTIVE TODAY, 04/04/2024 THE FACILITY IS LICENSED TO SERVE A MAX. CAP OF 12 (WHEN THERE IS AN ASSISTANT PRESENT): WITH NO MORE THAN 4 INFANTS.
OR MAX CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. Notice of site visit posted and appeal rights were provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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