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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622055
Report Date: 08/14/2024
Date Signed: 08/14/2024 03:13:08 PM

Document Has Been Signed on 08/14/2024 03:13 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:BOYKO, NATALIAFACILITY NUMBER:
343622055
ADMINISTRATOR/
DIRECTOR:		BOYKO, NATALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 470-6898
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Natalia BoykoTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 8/14/24 at approximately 12:30PM, Licensing Program Analyst (LPA) Michelle Perez met with one of the assistants Vicktoriia Kryvoruchko for an unannounced inspection. Licensee was not initially present, but arrived within 15 minutes. During the inspection there was a census of 08 CHILDREN supervised by the licensee and assistants. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are 24- hours (if needed) Monday through Sunday.

A health and safety inspection was conducted in the areas accessible to children. The off-limit areas are include: 2nd and 3rd floors, office area, pool area, side yard, garage. Licensee understands that children may never enter these off-limits areas. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. LPA observed all required postings. LPA observed home was safe, orderly, and free of hazards. LPA advised the licensee that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock. The licensee stated that there are no firearms. There is a swimming pool that has a self-latching gate with 5' fence.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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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: BOYKO, NATALIA
FACILITY NUMBER: 343622055
VISIT DATE: 08/14/2024
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LPA observed a children's roster and fire drill log, the last fire drill was conducted July 2024.. Licensee's has CPR and expired 08/2025. Mandated Reporter expires on 1/2026. Licensee’s Licensee understands both training’s must be completed every two years. LPAs reviewed records of children’s files, all which contained the required documentation.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the Licensee. A notice of site visit was provided and must remain posted for 30 days

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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