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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625666
Report Date: 08/05/2024
Date Signed: 08/05/2024 10:40:55 AM

Document Has Been Signed on 08/05/2024 10:40 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:KASHIRSKII, ANDREIFACILITY NUMBER:
343625666
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Andrei KashirskiiTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On August 5, 2024, at approximately 08:45 AM, Licensing Program Analyst (LPA), Michelle Perez, met with licensee Andrei Kasherskii and spouse Margarita Kashirskaia for the purpose of a case management, with deficiencies. Upon arrival there were 3 children in care.

On July 17, 2024, LPA received a complaint and conducted interviews as part of the investigation. Through the course of the interview process, LPA found that licensees spouse, Margarita Kashirskaia was present within the facility, several times during the operating hours, providing care for children and greeting families. Further, LPA found when speaking to licensee, it was admitted that spouse was not associated to the facility.

Spouse did not have an active criminal record clearance associated to licensees facility from when the facility was licensed on March 14, 2024 through July 28, 2024, and therefore was not cleared to be present.

Due to the information obtained, a citation A is being cited for not having a criminal record clearance transferred to Kashirskii's facility.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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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Document Has Been Signed on 08/05/2024 10:40 AM - It Cannot Be Edited


Created By: Michelle Perez On 08/02/2024 at 12:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KASHIRSKII, ANDREI
FACILITY NUMBER: 343625666

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2024
Section Cited
CCR
102370(D)(2)

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Criminal record clearance transfer was not completed.
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
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Licensee associated spouse to facility upon the request of LPA. Licensee has acknowledged that he understands all adults who plan to be present in the facility, working and/or volunteering more than 16 hours a week, must have a active criminal record clearance associated to facility.
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Request a transfer of a criminal record clearance as specified in Section 102370(j)
This was not evidenced by: LPA conducting interviews with prior families and licensee acknowleding he did not associate his spouse.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Michelle Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2024


LIC809 (FAS) - (06/04)
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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: KASHIRSKII, ANDREI
FACILITY NUMBER: 343625666
VISIT DATE: 08/05/2024
NARRATIVE
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Licensee must have this report available for all families, currently enrolled and new families, to review and sign the LIC 9224, to acknowledge they have read this report. All incoming families for 1-year (until 8/5/2025) must read and review this report and sign the LIC 9224. The LIC9224 must remain in the files of each child that is enrolled. Failure to do so will result in a subsequent citation.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

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

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