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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500798
Report Date: 10/30/2024
Date Signed: 10/30/2024 01:19:35 PM

Document Has Been Signed on 10/30/2024 01:19 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:POLYNKO, ALYONAFACILITY NUMBER:
344500798
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/30/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Alyona PolynkoTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 10/30/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted an unannounced Case Management inspection for the purpose of a Change in Capacity. Licensee Alyona Polynko (L1) requested an increase in capacity from 8 children to 14 children. A fire clearance, dated 10/29/2024, has been received by LPA and is on file with the Department. LPA arrived at the Family Childcare Home (FCCH) and was met by L1. LPA disclosed the purpose of the inspection and was granted entrance into the FCCH. Also present in the FCCH was L1's spouse. LPA observed a census of 1 infant child and 4 preschool aged children. LPA accessed Guardian and determined that all required individuals subject to a background review had obtained a criminal record clearance and were associated to the license.
LPA toured the on-limits areas of the FCCH. A health and safety inspection was conducted in areas accessible to children. The OFF-limits areas include garage, laundry room, entire upstairs, downstairs closet, pool pump enclosure, and side yards. A1 understands that OFF-limits areas must remain inaccessible to children in-care. LPA discussed ratios for a large capacity, documents required for staff or adult assistants, and LIC 9150 was provided for parents. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information.
Effective today, 10/30/2024, the facility is approved for a LARGE capacity to serve 12 children (when there is an assistant present) with no more than 4 infants OR a capacity of 14 children with no more than 3 infants, and when 1 child is in Kindergarten or Elementary School, and 1 child is at least aged 6 years old. Infants are children under the age of 24 months old. L1 understands that when there is no assistant present, the facility must revert back to the ratios of a small capacity.
NO DEFICIENCIES were observed in the areas that were evaluated on 10/30/2024. An exit interview was conducted, and the report was reviewed with Licensee Polynko. LPA provided Licensee Appeal Rights to L1. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
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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