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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500798
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:22:56 PM

Document Has Been Signed on 04/26/2023 12:22 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:POLYNKO, ALYONAFACILITY NUMBER:
344500798
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/26/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Alyona PolynkoTIME COMPLETED:
12:30 PM
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On 04/26/2023, Licensing Program Analyst Katy Maestas (LPA) met with Applicant Alyona Polynko (A1) for the purpose of a second pre-licensing inspection. LPA disclosed the purpose of the inspection and was granted entrance into the Family Childcare Home (FCCH). Also present in the FCCH was A1's husband and minor child. A1’s primary language is Russian; translation was not necessary. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. A1’s tentative hours of care are Monday through Friday, from 8:00 AM until 6:00 PM. A1 does not intend on providing overnight or weekend care.
A health and safety inspection was conducted inside the areas of the home that are accessible to children in care and outside of the FCCH. A1 accompanied LPA for the entirety of the tour. LPA verified that toxic and hazardous items were inaccessible to children in care. LPA observed a baby-gate barricading the stairway from children in care. LPA observed that a lock had been installed which prevents the sliding glass door from opening to the back yard.The outdoor play area was toured which includes the backyard and a pool. LPA observed that a substantial portion of the fence surrounding the backyard is down and the yard is not fully enclosed. A1 stated that she will provide 100% supervision of day care children when they are outside. A1 is currently working with the neighbor and insurance company to have the fence fully repaired. A1 understands that she must notify Licensing and LPA must do an inspection BEFORE day care children are allowed outside in the backyard without A1's supervision. LPA inspected the pool and it's surrounding fence. LPA measured the mesh fencing to be 5 feet high with a self closing and self latching gate.The OFF-limits areas of the FCCH are the garage, laundry room, closet (near the stairway), entire 2nd floor, side yards, and pool pump enclosure. A1 understands that OFF-limits areas must remain inaccessible to children in care.As of today, 04/26/2023, A1 is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, OR up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least aged 6 years. Infants are children under the age of 2. An exit interview was conducted and the report was reviewed with A1. LPA provided A1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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