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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625083
Report Date: 02/28/2024
Date Signed: 02/28/2024 01:20:36 PM

Document Has Been Signed on 02/28/2024 01:20 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KALINOVSKIY, NATALYAFACILITY NUMBER:
343625083
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/28/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Natalya KalinovskiyTIME COMPLETED:
01:45 PM
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On Wednesday, February 28, 2024, Licensing Program Analyst (LPA) Amanda Sutter met with licensee Natalya Kalinovskiy for an unannounced case management inspection. Licensee requested to make bedroom 1 and front yard on limits. LPA observed front play yard to be fenced. Licensee provided an updated facility sketch to LPA Sutter during inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Four children were present in the facility.

A health and safety evaluation was conducted in all areas accessible to children. Off-limit areas will include: bedroom 2, bedroom 3, garage, and entire backyard. Licensee acknowledged that children may never enter these off-limit areas. LPAs observed that the facility is clean, safe, sanitary, and in good repair.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. Exit interview was conducted. A notice of site visit is posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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