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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407563
Report Date: 07/15/2021
Date Signed: 07/15/2021 02:07:15 PM

Document Has Been Signed on 07/15/2021 02:07 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SHAVRATOV FAMILY CHILD CARE HOMEFACILITY NUMBER:
485407563
ADMINISTRATOR:SHAVRATOV, ZINAIDA & EFIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 305-1857
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensees, Efim and Zinaida ShavratovTIME COMPLETED:
02:15 PM
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On 7/15/2021 at 12:45am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Kirk Marks. A review of staff records on 7/07/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently four adults living in the home.

At 1:00 the home was toured inside and outside. The licensees were supervising three children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:00am to 5:00pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the garage , one downstairs bedroom and attached bathroom, and the entire upstairs which includes three bedrooms, two bathrooms and laundry room, and were made inaccessible by door locks and a locking gate at the bottom of the stairs. Poisons are locked in an outside shed. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. There is no fireplace contained in the home. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home.

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SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SHAVRATOV FAMILY CHILD CARE HOME
FACILITY NUMBER: 485407563
VISIT DATE: 07/15/2021
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There are play yards available for napping infants. Play yards have firm mattresses and are free of loose objects. Bedding is laundered weekly, and soiled bedding is stored inaccessible to infants. Napping infants are checked on every 15 minutes, and checks are documented on child's sleeping log. No infants were observed to be swaddled, and infants under 12 months are placed on their backs for sleeping.

The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard.

Three children's records were reviewed at 1:20; required emergency information forms were observed to be on file. Individual Sleeping Plans were on file for infants under 12 months of age. The licensee and all employees have the required immunizations on file. The licensees have current pediatric CPR and First Aid certification, which expire on 05/2023.

This report was reviewed and discussed with the licensees. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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