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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415675
Report Date: 01/09/2020
Date Signed: 01/09/2020 11:36:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BASHIROVA, LIUDMILAFACILITY NUMBER:
434415675
ADMINISTRATOR:BASHIROVA, LIUDMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 657-3157
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:14CENSUS: 11DATE:
01/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Liudmila BashirovaTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Tuoc Doan and Pietro Hernandez conducted an unannounced site visit to the day care home for a case management. LPAs met with Licensee Liudmila Bashirova. The purpose of the visit is to inspect and verify that the fence that surrounds the swimming pool to ensure inaccessibility of the pool meets applicable law and Title 22 Regulations for fencing requirement.

Licensee had submitted plans to bring the fencing into compliance and notified LPA of the completed work. During inspection today, LPAs observed the completed work. The fence that surrounds the swimming pool is now five feet high and any gaps or void do not allow passage of a sphere equal to or greater than four inches in diameter.

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection.

Exit interview was conducted where this report was reviewed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN ENTRANCE INTO THE HOUSE FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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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