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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621849
Report Date: 06/06/2024
Date Signed: 06/06/2024 11:55:20 AM

Document Has Been Signed on 06/06/2024 11:55 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SOLOVIOVA, SVITLANAFACILITY NUMBER:
343621849
ADMINISTRATOR/
DIRECTOR:		SOLOVIOVA, SVITLANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 297-8262
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 16DATE:
06/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Svitlana SoloviovaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 6/6/2024, at approximately 8:40AM, Licensing Program Analyst (LPA) Michelle Perez, arrived for the purpose of a complaint investigation. Upon arrival, LPA witnessed 16 children in care, with three assistants. Licensee was not present. Licensee arrived approximately 30 minutes later.

LPA documented the names of the assistants. Two assistants were associated to the facility and one was not. Galina Putlina, was not associated to the facility, therefore the facility failed to transfer the criminal record clearance for this individual. Licensee stated that Galina operates her own family childcare, and asked to be relocated to this facility for two days, due to repair work being done at her own family child care.

A caregiver background check, civil penalty will be assessed of $100 per day, for the total amount of days Galina was present along with an "A" citation.

Licensee explained that Galina will not be present moving forward.

Title 22 deficiency is cited on 809D
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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Document Has Been Signed on 06/06/2024 11:55 AM - It Cannot Be Edited


Created By: Michelle Perez On 06/06/2024 at 10:45 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SOLOVIOVA, SVITLANA
FACILITY NUMBER: 343621849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2024
Section Cited
CCR
102370(D)(2)

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Criminal record clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
Request a transfer of a criminal record clearance as specified in Section 102370(j)
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Licensee explained that assistant Galina Putlina will not be present after today's visit.

LPA will condcut a visit at a later date to confirm that assistant is no longer present.
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This was not evidenced by: LPA witnessing an assistant present, without a criminal record transfer to the facility. Licensee expressed that assistant had been present for two days.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Michelle Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024


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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SOLOVIOVA, SVITLANA
FACILITY NUMBER: 343621849
VISIT DATE: 06/06/2024
NARRATIVE
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Licensee is required to have all current guardians/parents read this report and sign the LIC 9224, acknowledgment of licensing reports. Thereafter, all NEW and INCOMING families must read the report and sign the LIC9224. ALL LIC9224s, shall be placed in EACH of the children's files. Failure to sign & place the LIC 9224 in each of the children's files, will result in subsequent citations.

This report is to be made available and placed in a conspicuous location, for 30-days.

This report was reviewed with licensee, a notice of site visit was provided with appeal rights.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
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