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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573617096
Report Date: 01/26/2023
Date Signed: 01/26/2023 09:42:41 AM

Document Has Been Signed on 01/26/2023 09:42 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:PENKOV, PETER & TATIANA/PENKOVA, VIKTORIYAFACILITY NUMBER:
573617096
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/26/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Tatiana PenkovTIME COMPLETED:
10:00 AM
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On January 26, 2023, Licensing Program Analysts (LPAs) Lauren Scott and Mariya Melnichuk, met with licensee, Tatiana Penkov for the purpose of going from inactive to active status. Licensee is also pending an increase in capacity, from small to large.

LPA's toured the home and checked all on limits areas of the home. The home consists of 3 bedrooms, 2 bathroom, a basement, detached garage, detached studio and backyard with an in ground pool. The pool is fenced per Title 22 guidelines. The off limits areas include: bedroom 2, bathroom 1, detached studio, basement and detached garage. Licensee understands that no children are allowed in these areas. In order to make these areas on limits, licensee must notify CCLD prior to children going into these area.
LPAs reviewed required documents with licensee for children, staff, and adults in the home. LPAs also discussed required forms and documents to be kept on site and posted.

LPA observed hazardous items properly stored out of children's reach. Licensee stated there are no weapons in the home. Fire extinguisher and smoke detector meet regulation.

Effective today, 1/26/23, this home is back to active status for a small 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 Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted and Notice of Site Visit was provided.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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