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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343627358
Report Date: 08/27/2025
Date Signed: 08/28/2025 08:52:23 AM

Document Has Been Signed on 08/28/2025 08:52 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:EYRIKH, YELENAFACILITY NUMBER:
343627358
ADMINISTRATOR/
DIRECTOR:		EYRIKH, YELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 212-3326
CITY:ELVERTASTATE: CAZIP CODE:
95626
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 0DATE:
08/27/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Yelena EyrikhTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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On August 27, 2025 at 8:30 AM, Licensing Program Analyst (LPA) Tanya Washington met with Applicant Yelena Eyrikh for the purpose of a scheduled pre-licensing/ change of location inspection. There were no other adults or children present in the home. Applicant was previously licensed at #343624123. All adults residing in the home have obtained required fingerprint clearances. The hours of operation will be Monday-Friday from 7 AM to 6 PM.

Applicant owns the home and control of property has been verified. Applicant has applied for a fire clearance and currently awaiting inspection which is scheduled for 08/28/2029.

LPA and Applicant conducted a tour of the entire home inside and out for health and safety hazards. This facility is a single story home which has four bedrooms, three bathrooms, living room, dining room, family room, kitchen, two playrooms, and a fenced front and backyard. The backyard is split into to sections. The section directly behind the home has a gazebo, there is a swing set and children's toys located closer to the front of the yard. The back portion of the yard is fenced off and has four long barns. The off limit areas will include: master bedroom located next to kitchen area, laundry room, bathroom closest to the laundry room, three bedrooms on the opposite side of the master bedroom and backyard area past the fence. Applicant acknowledged that off limit areas must remain inaccessible to children. Applicant was notified that she would need to contact the department before making any on-limits areas to off-limits or vice versa.

All of the toxic or dangerous materials are inaccessible. The facility has a working telephone, fully charged fire extinguisher, first aid supplies and a smoke detector that meets regulations. The facility did not have a carbon monoxide detector. As per the applicant, there are no firearms or weapons in the facility. All sharp objects and cleaning solutions are stored out of children's reach. There is a fireplace located in the family room which applicant will not use for heat purposes. There are no bodies of water on the premises and applicant stated that there are no seasonal bodies of water on the premises that she is aware of.

Report continued on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Tanya Washington
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2025
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 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: EYRIKH, YELENA
FACILITY NUMBER: 343627358
VISIT DATE: 08/27/2025
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Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the licensing regulations, safe sleep procedures, and provided applicant with information on how to access PINs online at the CCLD website. Applicant has submitted record of all the required immunizations. Applicant's CPR and First Aid certificate is valid until 12/2025. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. The applicant understands that baby walkers and smoking are prohibited within the facility. Applicant also understands that she is required to have a crib or a playpen for all infants under two years old.

Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm



A copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request.

- Prior to licensure:
- A fire clearance is required to obtain a large license
- Ensure that the legs of the swing set are mounted to the ground
- Send proof of installed carbon monoxide detector
NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Tanya Washington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC809 (FAS) - (06/04)
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