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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625451
Report Date: 05/08/2024
Date Signed: 05/08/2024 02:38:22 PM

Document Has Been Signed on 05/08/2024 02:38 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KONTSEMAL, ANASTASIIAFACILITY NUMBER:
343625451
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/08/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Anastasiia KontsemalTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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 May 8, 2024, Licensing Program Analyst (LPA), Michelle Perez, made an unannounced visit to clear the deficiencies cited on 04/29/2024. The deficiencies cleared were a type A for leaving an infant to sleep alone with the door closed inside of the family childcare without supervision. The second type A was for an uncleared adult assistant, who was present within the facility. The type B was due to not having CPR for the adult assistant, when left alone in the childcare to provide supervision.

Upon arrival LPA did not witness any children in care. LPA spoke to the licensee who had made changes to avoid repeat violations. The uncleared adult assistant, did not return to the childcare for employment. All adult assistants have current CPR which was also submitted via e-mail to the department. Licensee also explained that she is aware of the infant sleep regulations, and has explained this to all of her assistants. The assistant who left the infant alone, while sleeping, has not returned to work in the facility.

Licensee expressed that she is aware of the how and why the issues occurred and the changes made will ensure no repeat violations will reoccur. Licensee understands all assistants must have a criminal record clearance before working within the family childcare home.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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 2
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: KONTSEMAL, ANASTASIIA
FACILITY NUMBER: 343625451
VISIT DATE: 05/08/2024
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
26
27
28
29
30
31
32
LPA did not observe any concerns during today's visit. LPA advised licensee to please let the department know when the facility will be closed, as licensee was not officially offering childcare during today's visit due to family plans.

LPA Perez was able to clear the violations for the licensee during the visit, based on information obtained.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2