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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624401
Report Date: 12/01/2023
Date Signed: 12/01/2023 10:23:47 AM

Document Has Been Signed on 12/01/2023 10:23 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:KOPYTOVA, NATALIAFACILITY NUMBER:
343624401
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
12/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Natalia KopytovaTIME COMPLETED:
10:25 AM
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On December 1, 2023 at 9:00 AM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee, Natalia Kopytova for an unannounced case management inspection to increase capacity to the maximum number of 14 children. The visit was conducted in Russian language. Upon arrival, Licensee and her adult daughter were providing care and supervision to five children. LPA reminded Licensee that children related to her count in ratio and capacity until they turn 10 years old. Everyone residing in the home have obtained the required fingerprint clearance. Facility hours and days of operation are Monday- Friday from 8 AM to 6 PM.

Licensee owns the premises and control of property was verified.
On November 30, 2023, Sacramento Metropolitan Fire Department granted a fire clearance.

The off limit areas in the home include both bedrooms and garage. Licensee acknowledged that children may never enter these off limit areas. Per licensee, there are no weapons on the premises. Infant safe sleep guidelines were discussed. LPA also discussed capacity and ratios with and without and assistant.

There are no bodies of water on the premises.
Licensee's CPR and First Aid certification is valid until 05/2024.

EFFECTIVE TODAY, 12/01/2023 THE FACILITY IS LICENSED TO SERVE A MAX. CAP OF 12 (WHEN THERE IS AN ASSISTANT PRESENT): WITH NO MORE THAN 4 INFANTS.
OR MAX CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. Notice of site visit posted and appeal rights were provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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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