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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700238
Report Date: 03/28/2022
Date Signed: 03/28/2022 09:27:05 AM

Document Has Been Signed on 03/28/2022 09:27 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHELAKHSAEVA, EMMAFACILITY NUMBER:
015700238
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
03/28/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Emma Chelaksaeva- LicenseeTIME COMPLETED:
09:40 AM
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On 3/28/22 at 9:15am, Licensing Program Analyst Briana Plumboy, met with licensee Emma Chelaksaeva for an UNANNOUNCED POC INSPECTION. Present for this visit was 1 infant, 3 preschool age children, 1 school age child, and fingerprint clear and associated assistant Halyna Sernetska.

The facility is in ratio today. LPA Plumboy cleared the deficiency which was cited on 3/23/22 for capacity/ratio.

LPA Plumboy provided licensee a clearance letter for the ratio/capacity citation.

There are no deficiencies cited today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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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