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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625191
Report Date: 10/30/2024
Date Signed: 10/30/2024 12:24:04 PM

Document Has Been Signed on 10/30/2024 12:24 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:DYACHISHIN, ANNETTEFACILITY NUMBER:
343625191
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/30/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Annette DyachishinTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 10/30/2024 Licensing Program Analyst met with licensee Annette Dyachishin, for the purpose of a capacity increase. During today's visit there was 6 children present, including licensees own infant child. All adults present today have a cleared criminal record clearance.

LPA toured and observed the changes that were required by the fire department. Licensee made changes to the location of the fire extinguisher and the fire pull alarm. Licensee changed the door handles on the rooms in the hallway, including the childcare room.

Effective today, licensee is approved for a large family childcare home. The childcare is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years.

A notice of site visit was provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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