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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409090
Report Date: 03/22/2022
Date Signed: 03/22/2022 03:10:05 PM

Document Has Been Signed on 03/22/2022 03:10 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LEVINA, VALENTINAFACILITY NUMBER:
073409090
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Valentina LevinaTIME COMPLETED:
03:30 PM
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On 3/22/22 Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts conducted a Case Management inspection at Valentina Levina's family home. Licensee has applied for CAPACITY INCREASE from 8 to 14 children .

Fire clearance was granted and licensee has met all Fire Department requirementS. All Licensing documents and requirements have been met. Licensee understands that parents have to be notified and Parent Notification for Additional Children in care LIC9150 has to be maintained in child files. Licensee's daughter-in-law and an assistant will be the additional helpers in the home. LPA explained the capacity and limitations of a Large Family Childcare Home. Licensee understands the ratio requirements of large home.

LPA inspected all areas of the home inside and outside.
IN USE:: Family room, Bathroom, Bedroom, Den, Side Yard
OFF LIMIT: Rest of home which includes- Kitchen, Dining, 4 bedrooms, 3.5 bath, pool, patio, spa

During inspection on 2/2/22 Licensee agreed to lock access door from Family room to rest of the indoor areas in home; and install locks on 2 side yard gates that lead into shed/pool area and driveway. During today's inspection LPA observed they are not locked. Per Licensee Valentina, the fire inspector told them not to lock the doors/gates as they need to be easily opened in case of emergency. LPA reiterated need for extra visual supervision when children are near these exits.
Licensee will send an updated Emergency Disaster Plan LIC610A and copy of her CPR First Aid by end of 3/23/22. Facility is approved for LARGE CHILDCARE HOME effective 3/23/22. Report was reviewed and exit interview conducted with Licensee Valentina.
NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
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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