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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004375
Report Date: 12/29/2022
Date Signed: 12/29/2022 01:52:50 PM

Document Has Been Signed on 12/29/2022 01:52 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:TAVROVSKY, NICOLE & TAVROVSKY,VICTORIAFACILITY NUMBER:
384004375
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/29/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Nicole TavrovskyTIME COMPLETED:
01:30 PM
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On December 29, 2022 at approximately 12:30pm, Licensing Program Analyst (LPA) Winnie Ly conducted an Case Management Visit for an increase of capacity from a small family child care home to a large family child care home. LPA Ly met with Licensees Nicole Tavrovsky and Victoria Tavrovsky. Purpose of visit was explained. No children present during today's visit as facility is currently closed for the holidays.

The day care areas are on the ground level consists of Day-care Living room, Day-care Kitchen, Day-care Room #1, Day-care Room #2, Day-care Bathroom #1, Day-care Bathroom #2, a Bedroom and the Yard. Off limit are on the ground level is the garage. Off limit on the second floor level is the entire second level.

During today's visit LPA Ly and licensee Nicole Tavrosky toured the home for health and safety check. LPA observed the home is clean orderly and properly ventilated. LPA also observed a 2A10BC Fire extinguisher, operable smoke detectors and carbon monoxide. There are no Fireplace or bodies of water in the home. Electrical outlets have child protective covers in place making them inaccessible to children. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. Home has age appropriate toys and equipment available for the children in care.

A fire clearance was granted by the San Francisco Fire Department on 12/13/2022.


A Large Family Child Care Home License if effective today 12/29/2022.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2022
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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