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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624842
Report Date: 05/14/2024
Date Signed: 05/14/2024 10:19:41 AM

Document Has Been Signed on 05/14/2024 10:19 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:MOTHERSHED MANAFOV, TIYANNAFACILITY NUMBER:
343624842
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Tiyanna Mothershed ManafovTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the licensee, Tiyanna Mothershed Manafov, for an inspection of plan of correction. Licensee's day care was inspection previously on March 21, 2024 and citations were given. Purpose of today's inspection to verify the corrections being made.

During today's inspection, there are two children in care with licensee and one helper. During inspection, LPA observed the licensee has an updated fire drill log. Per the log, last drill was conducted on April 18, 2024. LPA observed the licensee has an updated children roster on file. LPA reviewed the children files and observed the licensee has all of the required documents on file, including emergency contact information of each child in care. LPA observed licensee has immunization record of the staff, including TB test clearance, and the staff has completed the Mandated reporter training. Per certificate, the training is valid until April 14, 2026. LPA answered licensee's child care related questions.


During today's inspection, LPA did not observe any violation of regulations. All previously issued citation has been corrected. No new citation was given. Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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