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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409560
Report Date: 01/13/2025
Date Signed: 01/13/2025 03:37:53 PM

Document Has Been Signed on 01/13/2025 03:37 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHEVCHENKO, OKSANAFACILITY NUMBER:
073409560
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
01/13/2025
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Oksana ShevchenkoTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 1/13/25, at 2:40PM, Licensing Program Analysts (LPAs) Mario Caro and Catherine Fernandes arrived announced on a Licensee initiated case management inspection and met with Licensee Oksana Shevchenko. Present in care were four preschoolers.

The purpose of the inspection was to add a previous off limit bedroom to her limit areas, LPAs inspected the bedroom and allowed it to be used as of today's date. While at the home LPAs did a walk through of the home.

The on limits areas are the: living which is the main area of the day care, the master bedroom which has been split into areas (which will be used as a walk through space to get to the master bathroom), the bedroom at the end of the hall on the right side of the house and the fenced in backyard.

There is a small play structure in the backyard that needs to be mounted in to the ground.

The off Limits areas are the: kitchen, left half of the master bedroom, the first bedroom on the right side of the house, the laundry room, the bathroom, the converted detached garage and the front yard play area.

There is a large wooden play structure in the front yard, Licensee stated that the front yard is not a play space for the children in care and is an off limit area.



Exit interview conducted with Licensee
Report, Notice of site visit and Appeal Rights provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Mario Caro
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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