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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625666
Report Date: 07/30/2024
Date Signed: 07/30/2024 02:28:03 PM

Document Has Been Signed on 07/30/2024 02:28 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:KASHIRSKII, ANDREIFACILITY NUMBER:
343625666
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/30/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Andrei KashirskiiTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On July 30, 2024 at approximately 1:20PM, Licensing Program Analyst ( LPA), Michelle Perez, met with Andrei Kashirskii for the purpose of a Plan of Correction (POC) visit.

On 7/23/2024- Licensee was cited for over ratio (102416.5 (a)).

LPA returned to verify that licensee was adhering to ratio regulations. There were no children present during today's visit, but two new children (infants) had been enrolled. LPA verified the children's roster.

Licensee is aware of the ratio for a small family child care and stated he will adhere to small family ratios.

LPA cleared the deficiency today, July 30, 2024.

A notice of site visit was provided and this report was reviewed with the licensee.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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