<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625019
Report Date: 03/04/2024
Date Signed: 03/04/2024 09:12:49 AM

Document Has Been Signed on 03/04/2024 09:12 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:TSYGANIUK, VERONIKAFACILITY NUMBER:
343625019
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Veronika TsyganiukTIME COMPLETED:
09:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On March 4, 2024, Licensing Program Analyst (LPA), Michelle Perez, met with licensee Veronika Tsyganiuk, for the purpose of an announced, case management visit. Licensee has requested to utilize the backyard and daughter's room, and make them both on limits. Present was licensee's mother and infant daughter.

LPA toured the backyard and found no hazards present. Licensee plans to utilize backyard for children and add additional play equipment that is age appropriate. The backyard is fully fenced.

LPA toured daughter's bedroom, which will be utilized for nap time with mat's placed on the floor. LPA did not find any toxic or hazardous materials present. Licensee will ensure that all lotions and/or medications will be out of reach when children are present in the room.

Off limit areas will now be, the garage and master room only.

Effective today 3/4/2024, the backyard and the daughter's room will be on limits and ready for use by children in care.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1