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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415675
Report Date: 11/14/2019
Date Signed: 11/14/2019 09:57:52 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:
11/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Liudmila BashirovaTIME COMPLETED:
10:05 AM
NARRATIVE
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Licensing Program Manager (LPM) Sandy Knight, and Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced site visit to the day care home for a case management. LPM and LPA met with Licensee Liudmila Bashirova and explained to her the purpose of the inspection.

LPA and LPM inspected the swimming pool and its fence enclosure located in the backyard with Licensee. Measurement and photos of the fence were taken.

Based on measurement taken and observation, the fence that surrounds the swimming pool to ensure inaccessibility of the pool does not meet applicable law and Title 22 Regulations for fencing requirement.

LPA and LPM reviewed fencing requirements for swimming pool with Licensee.

In the areas that were evaluated, one regulatory violation was observed.
Exit interview was conducted, where this report, the violation, plan of correction, and appeal rights were 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: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BASHIROVA, LIUDMILA
FACILITY NUMBER: 434415675
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2019
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME. All licensees shall ensure the inaccessibility of pools [...] through a pool cover or by surrounding the pool with a fence.
Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view [...].
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Based on measurement taken during the inspection, the fence that surrounds the pool to ensure inaccessibility of the the pool is less than five feet high. Some parts of the top of the fence swag downward. This poses a potential risk to the health and safety of children in care.
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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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2019
LIC809 (FAS) - (06/04)
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