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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626608
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:04:03 PM

Document Has Been Signed on 02/27/2025 12:04 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:HRYTSYUK, LYUBOVFACILITY NUMBER:
343626608
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/27/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Hrytsyuk, LyubovTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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At 9:15 a.m. on Thursday, February 27th, 2025, Licensing Program Analyst (LPA) Pa Dao Vang met with Applicant, Lyubov Hrytsyuk, for the purpose of an announced, pre-licensing inspection. There were no children present in the home. Applicant’s husband is also home during the inspection. Facility hours of operation are from 8:00 a.m.- 6:00 p.m., Mondays thru Fridays.

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

APPLICANT OWNS THE HOME: The applicant provided proof of control of property. Applicant understands that, once licensed, they can only operate with a maximum capacity of 8 children at a time.

The one story home consists of 2 bedrooms, master bedroom with bathroom, 1 bathroom, living/dining room, laundry, garage, kitchen, gated backyard with jacuzzi, gated side yard, and front yard. Off limits area includes the bedrooms #1, bedroom #2/master bedroom with bathroom, front yard, and gated backyard. LPA observed a non-working and empty jacuzzi with a cover located behind the house and garage in the backyard. Applicant plans to remove the jacuzzi within a year. Applicant understands that their own grandchildren under 10 years old will count toward the childcare ratio when present during childcare hours. LPA observed functioning smoke alarm and carbon monoxide detectors, and a working 2A-10-BC fire extinguisher.


There are no other bodies of water. Applicant understands 100% supervision shall be maintained in or around bodies of water, and in unfenced areas. Applicant stated that there are no smoking, weapons nor poisons in the home. Cleaning compounds, knives and medications are placed on high shelves, inaccessible to children. Continue report on LIC809-C...
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HRYTSYUK, LYUBOV
FACILITY NUMBER: 343626608
VISIT DATE: 02/27/2025
NARRATIVE
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Applicant has completed the required Preventative Health and Safety course which includes 1 hour of nutrition and lead prevention training. CPR and First aid certification were verified and will expire 12/14/2026. The Mandated Reporter Training certificate also expires on 11/19/2026. Applicant understands that CPR/First Aid and Mandated Reporter Training certifications must be renewed every 2 years. LPA provided blank forms required for children's records including Immunization Card, Consent for Medical Treatment, Parent’s Rights, Emergency Identification, Parent Notification Additional Children in Care, Individual Sleep Plan, and Affidavit Regarding Liability Insurance. LPA also reviewed all the required forms for each child’s personnel file to be kept at the facility.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA observed a crib free of loose objects in the facility. LPA discussed about the infant sleep log required for each child under the ages of 1years old. Licensee must check and documenting each infant sleeping every 15 minutes. LPA provided an example of the 15 minutes sleep log to applicant.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if they relocate and wants to continue to provide care, they must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624B shall be submitted within seven days to remain in compliance.

Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months. Smoking prohibition and regional office relocation were discussed.

Continue report on LIC809-C...
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HRYTSYUK, LYUBOV
FACILITY NUMBER: 343626608
VISIT DATE: 02/27/2025
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Applicant understands to pay the annual fees of $73.00 before the due date. The annual bill will be sent through the mail with facility number, pin, and the amount of it. Applicant can pay it through the department website at https://cdss.ca.gov/inforesources/community-care/licensing-fees . They may also pay in person in our office or mailing with check/Money Order/personal check to the address listed below:

CA Department of Social Services
MS 9-3-67
P.O. Box 944243
Sacramento, CA 94244-2430

On this date, 1/24/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.


This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining to family childcare homes.

Effective today, Thursday, February 27, 202524, facility is approved for a Small Family Child Care Home license, with a capacity of 6 children with no more than 3 infants, or 4 infants only. The maximum capacity of 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of two years.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
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