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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100496
Report Date: 07/19/2021
Date Signed: 07/19/2021 11:56:05 AM

Document Has Been Signed on 07/19/2021 11:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ZAYTSEVA, TATIANA FAMILY CHILD CAREFACILITY NUMBER:
376100496
ADMINISTRATOR:TATIANA ZAYTSEVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(401) 618-4449
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
07/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Tatiana ZaytsevaTIME COMPLETED:
12:15 PM
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On 7/19/2021 at 11:30 AM Licensing Program Analyst (LPA) Adrian Mangina conducted a Case Management visit. The purpose of this visit is amend a Case Management - Licensee Initiated report dated 5/26/21. At arrival, LPA met with Licensee Tatiana Zaytseva. Also present in the home were Licensee's Husband Alexey Livintsev and License''s two minor children there were no day care children in care. Facility was within ratio & capacity.

No deficiency cited today. An exit interview was conducted and a copy of the report (LIC809), and the Notice of Site Visit (LIC9213) was provided to the Licensee. LPA observed the Licensee post the Notice of Site Visit in a prominent place. Licensee states it is understood that this notice must be posted for 30 days.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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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